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Expense Reimbursement Form

Employee Name: Trivikrama rao Chitroju


Employee ID: AS016
Date: 18-06-2015
Sl No

Bill No

Bill Date

Purchase Details

Amount (Rs)

MF33432909

11-Jun-15

cab to office

244

G33445648

11-Jun-15

Cab from office

254

G33469465

12-Jun-15

cab to office

190

MF33480877

12-Jun-15

Cab from office

231

5
6
7
8
9
10

Total Amount in Rupees


In words:
Nine Hundred and Nineteen Rupees only
Prepared by
Name & Signature
Approved by
Somashekhar B
Name & Signature

919

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