Claim - Mobile Charges

Reference No. : 6003118800004

Employee Detail
Employee No.
Region

: 60031188
: Southern Region - I

Employee Name
Location

: Sriram Shivakumar
: Badvel

Grade
Department

: Workmen
: BADVEL

Level
Designation

: W4
: Tech Gr-IV

Claim Detail
Bill Date

Bill Amount ( INR)

Requested Amount
(INR)

02.07.2016

10.04.2016

329.00

329.00

0002

02.07.2016

23.04.2016

210.00

210.00

0003

02.07.2016

08.05.2016

210.00

210.00

0004

02.07.2016

25.05.2016

329.00

329.00

0005

02.07.2016

02.06.2016

329.00

329.00

0006

02.07.2016

28.06.2016

210.00

210.00

0007

02.07.2016

01.07.2016

500.00

500.00

Line Number

Entry Date

0001

Bill Number

Total Rquested Amount : Rs. 2117.00

Declaration
I hereby confirm that the documents submitted by me in support of my above claim are true and genuine in every
respect , If the said documents are found to be fraudulent / fabricated/ tampered , then I shall be liable for appropriate
disciplinary action by the Company.
I also confirm that I have referred the Claim Reimbursement Guidelines before raising this claim.

Signature of Employee
Mob. No: 9492337839