Flexi workforce - Conveyance / Other Expense claim form

Name of the Employee: HIMANSHU MISHRA Form filling date : 08-03-2019 To 09-03-2019
Employee code / id: Department: SALES
Mobile No: 9863986349 Location: AHMDBAD
Narration: Reimburesment for the period : 8/Mar/19 to 9/Mar/19 Cost center/Business Unit : RENAISSANCE HOTEL

Total Expenses Status

Mode of Travel Accomodation Misc Expenses ©

Date Purpose of visit From To Time in Time out Bus / Auto /'Taxi / Own Self Arranged DA Hotel
Dist in kms Amount
'(Vehicle)"* Hotel Name (Amount) (Amount)
(Amount) Total Details Amount
8/Mar/19 NDE HOME SAHARA GATE 9:30 9:45 8/3/2019 Xerox
8/Mar/19 NDE SAHARA GATE KALUPUR 10:00 2:30 RIKSHA 8KM 45.00 SRI BALAJI RESIDENCY 932 932 932.00 Stationery
8/Mar/19 NDE KALUPUR BALAJI HOTEL 2:33 3:00 TICKIT(BILL) 225KM 410 Internet
8/Mar/19 NDE BALAJI HOTEL RENAISSANCE 8:30 9:00 OLA FARE 15KM 145
9/Mar/19 NDE RENAISSANCE BALAJI HOTEL 6:20 7:00 BREAKFAST 50
9/Mar/19 NDE BALAJI HOTEL RENAISSANCE 8:30 9:00 RIKSHA 5 KM 25
9/Mar/19 NDE RENAISSANCE KALUPUR 5:00 6:30 RIKSHA 5 KM 25
9/Mar/19 NDE KALUPUR SAHARA GATE 9:30 2:00 TEA 10
9/Mar/19 NDE SAHARA GATE HOME 2:15 2:30 DINNER 165.00
9/3/2019
BREAKFAST 60.00 For Drivers *
RICKSHAW 5 KM 25
OLA FARE 15KM 232 Car washing*
DINNER 170.00
TICKIT(BILL) 225 410.00
Toll*
Parking*
Divided X

**Own Vehicle can be used subject to stated in the policy with necessary 1772.00 Total ( B ) 932.00 Total (C) 0.00
approvals/permissions directly from the Dept. Heads

Total (A) + Total (B) + Total ( C ) = Grand Total

1772.00 932.00
(A) + (B) + ( C) 2704.00

Rupees in Words : TWO THOUSAND SEVEN HUNDRED FOUR

I hereby declare that the information furnished by me is true to my knowledge and I Checked & Approved by (CFO/CEO/Group GM/GM) Checked & Approved by (CFO/CEO/Group GM/GM)
am aware that any discrepancy found may result in Termination of my Services

Employee Name : HIMANSHU MISHRA Name : HEMANG VYAS Name : _______________

Sign : Sign : Sign :