Sivaramaiah Nallabotu Expense Statement

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Local Conveyance Claim Form

Employee Name: Sivaramaiah Nallabotu


Department: Clinical Operations

Date

Vehicle (Personal
/ Company)

Expense Description
of Conveyance/
Others

Emp. ID: JSTL025


Designation: Sr. Manager

Start KM

05-09-15
Personal
06-09-15
Personal
07-09-15
Personal
08-09-15
Personal
Amount in words: Two thousand Two hundred Forty rupees
Note: KM- Kilometer

14568
14694
14851
14957

End KM

Total KM

14632 64
14774 80
14922 71
15022 65

Per KM
@Rs 8

8
8
8
8
Total
Amount:

Amount

HOD
(Sign.)

512
640
568
520
2240

Employee (Sign. & Date)

Executive Director (Sign. & Date)

Verified by HR (Sign. & Date)

Managing Director (Sign. & Date)

Finance & Accounts (Sign. & Date)

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