Travel Claim Form - Outstation

Name of Employee Designation Location Places Visited Purpose Date Employee's No. Grade Department Departure Time Arrival Date Time Duration Days Hrs

Travel - 1
Departure Date From Place Time Date Arrival To Place Time Travel Mode Class Self Paid by Co Fare Rs.

Total

Lodging - 2
Date From To Place Vr,No No of Days Hotel name Room Tarrif Laundry Tax (Rs.) Paid by Self Co Total Rs.

Total

Conveyance Expenses - 3
Date From - To self Paid by Co Mode Rs Date Vr. No

Boarding Expenses - 4
Remarks self Paid by Co Rs.

Total

Total

Allowance Payable - 5
Type of Allowances (5) City Allowance (6) Misc Expenses Total Total Cost of Tour (1 to 5) Less : Dept. Head / Date : Accounts Dept Received Cash Spl. Note for approval Authorised sign/Date Note : In case of insufficient space, you may write the additional information on the reverse side of this form. : Amount Spent by Company Advance drawn from Total Paid by Company (B) Difference due to / from Company (A-B) (B) (A) Date From To Days Duration Hours Rate per day Rs All. Payable Rs.

Empl. Sign. / Date :