Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

TELEECARE NETWORK (INDIA) PVT. LTD.

HUMAN RESOURCE DEPARTMENT




MONTHLY REIMBURSEMENT FORM (For the Month of ___________)

Name Employee No.
Dept. Designation
Instruction: Attach all original supporting bills / documents as per the serial
number, mention below.
To be filled by the employee To be filled by the HR
SN. Category Amount
(Rs. PM)
Entitlement
Up to
Amount
Passed
1. Fuel/Maintenance.
2. Entertainment


3. Drivers salary
(Receipt to be attached)

4. Medical expenses
(Related only to self
dependant family members)

5. News Paper and Periodicals.



TOTAL



I certify that above claims are
genuine & correct to the best of my
knowledge and information

Total Amount passed( in words)


Employees Signature


Authorized Signatory
Date: Date:
Employees are requested to submit this form to HR. Department by 10
th
of each Month..

You might also like