UEM INDIA PVT. LTD.

LOCAL MOTOR CYCLE CONVEYANCE CLAIM FORM

Employee Name :
Period From

Amitabh Singh
: 01 Feb 2015

Designation
To

28 Feb 2015

Motor Cycle # : RJ19-

Date

Details of Journey

From

To

Starting KM.

Last KM.

1-Feb-15

Official

Kudi H Brd

All Site & Office

32347

32398

2-Feb-15

Official

Kudi H Brd

All Site & Office

32398

32449

3-Feb-15

Official

Kudi H Brd

All Site & Office

32449

32508

4-Feb-15

Official

Kudi H Brd

All Site & Office

32508

32575

5-Feb-15

Official

Kudi H Brd

All Site & Office

32575

32629

6-Feb-15

Official

Kudi H Brd

All Site & Office

32629

32684

7-Feb-15

Official

Kudi H Brd

All Site & Office

32684

32732

8-Feb-15

Official

Kudi H Brd

All Site & Office

32732

32781

9-Feb-15

Official

Kudi H Brd

All Site & Office

32781

32837

10-Feb-15

Official

Kudi H Brd

All Site & Office

32837

32892

11-Feb-15

Official

Kudi H Brd

All Site & Office

32892

32942

12-Feb-15

Official

Kudi H Brd

All Site & Office

32942

33008

13-Feb-15

Official

Kudi H Brd

All Site & Office

33008

33065

14-Feb-15

Official

Kudi H Brd

All Site & Office

33065

33122

15-Feb-15

Official

Kudi H Brd

All Site & Office

33122

33183

16-Feb-15

Official

Kudi H Brd

All Site & Office

33183

33248

17-Feb-15

Official

Kudi H Brd

All Site & Office

33248

33301

18-Feb-15

Official

Kudi H Brd

All Site & Office

33301

33356

19-Feb-15

Official

Kudi H Brd

All Site & Office

33356

33407

20-Feb-15

Official

Kudi H Brd

All Site & Office

33407

33439

21-Feb-15

Official

Kudi H Brd

All Site & Office

33439

33482

22-Feb-15

Official

Kudi H Brd

All Site & Office

33482

33539

23-Feb-15

Official

Kudi H Brd

All Site & Office

33539

33591

24-Feb-15

Official

Kudi H Brd

All Site & Office

33591

33638

25-Feb-15

Official

Kudi H Brd

All Site & Office

33638

33692

26-Feb-15

Official

Kudi H Brd

All Site & Office

33692

33744

27-Feb-15

Official

Kudi H Brd

All Site & Office

33744

33793

28-Feb-15

Official

Kudi H Brd
All Site & Office
Total

33793

33851

Total Km. Running Amt. : 1504 @Rs.4/- per KM =

Date

Authorized By

Details of Journey

From

To

Starting KM.

Last KM.

Signatu

INDIA PVT. LTD.

MOTOR CYCLE CONVEYANCE CLAIM FORM

Feb 2015

Designation

Dy. CM

Motor Cycle # : RJ19-JS-0332

Total Run
KM.
51
51
59
67
54
55
48
49
56
55
50
66
57
57
61
65
53
55
51
32
43
57
52
47
54
52
49
58
1504
INR 6,016.00

Total Run
KM.

Signature of Claimant