REIMBURSEMENT COVERING SHEET

Agency Name
Name : Subrat kumar patra
Employee Code : IWS6594
Department : Deployment
SIEL Type : Outpar
Location : Bhubaneswar
Date : 15-Sep-19

Sr. No. Particulars From To Total

1 Local Conveyance 4,450

2 DA/ Tour Travel -

3 Conveyance -(Late sitting/ Weekend/ Holiday) -

4 Food Expenses -

5 Other Expenses (Mobile ) -

Total 4,450.00
Employee Name: Subrat kumar patra

Associate Signature :
(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action against me )

Checked & Approved by HR Section

Reporting Supervisor HOD/BM/RM/RSM/ZSM

Name : Mr. Lalatendu Mohapatra Name :

Signature : Signature :
 Local Conveyance Log sheet
Name : Subrat kumar patra
Employee Code : IWS6594
Department : Deployment
SIEL Type : Outpar
Location : Bhubaneswar
Date : 15-Sep-19
Claims for the month(s) of : Aug-19

Destination/Place Mode of Time @ Rs.5

Date Purpose (Site visit, Other etc.) Kms Total
From (Complete add.) To (Complete add.) Travel IN OUT /km

Ganganagar Bike 10:30am 4:00pm 95 5.00 475.00

2-Aug-19 Pipli,delang DU swap

Ganganagar Bike 10:00am 5:00pm 58 5.00 290.00

5-Aug-19 Lingaraj bihar,Ravitakies.sundarpada Integration&OADF

Ganganagar Bike 10:00am 5:00pm 20 5.00 100.00

6-Aug-19 Power house DU swap

7-Aug-19 Ganganagar Satasankha DU swap Bike 10:00am 6:00pm 80 5.00 400.00

Ganganagar Bike 10:00am 5:00pm 70 5.00 350.00

8-Aug-19 patia.pahal Alarm clearance.Atp 11A

Ganganagar Bike 10:00am 5:00pm 45 5.00 225.00

9-Aug-19 pahal Restoration material check

10-Aug-19 Ganganagar Patia,Sikhar chandi Installation Bike 10:00am 4:00pm 45 5.00 225.00

Ganganagar Bike 10:00am 6:00pm 30 5.00 150.00

13-Aug-19 Palaspalli Alarm clearance.Atp 11A

Ganganagar Bike 10:00am 5:00pm 45 5.00 225.00

14-Aug-19 Damana,Sikhar chandi Integration&OADF

Ganganagar Bike 05:00am 2:00pm 50 5.00 250.00

16-Aug-19 Bamikhal,Pahal ATP 11A and OADF

17-Aug-19 Ganganagar Sarakantra,Aiginia OADF test Bike 10:00am 5:00pm 52 5.00 260.00

Ganganagar Bike 10:00am 5:00pm 70 5.00 350.00

19-Aug-19 balipatna,Santarpur OADF test and Alarm clearance

21-Aug-19 Ganganagar Appolo hospital Installation Bike 10:00am 5:00pm 30 5.00 150.00

23-Aug-19 Ganganagar Appolo hospital oadf and atp 11A Bike 10:00am 5:00pm 30 5.00 150.00

Total 3600.00
Employee Name: Subrat kumar patra

Associate Signature :

(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action against me )

Checked & Approved by HR Section

Reporting Supervisor HOD/BM/RM/RSM/ZSM

Name : Mr. Lalatendu Mohapatra Name :

Name & sign of circle Head or mail approval

Signature : Name and sign of Area manager & above Signature :
 Local Conveyance Log sheet

Destination/Place @
Date Purpose Time Kms Total
From To Rs.3.5 /km

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

Total 0.00

Associate Signature :
(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action against me )

Checked & Approved by HR Section

Reporting Supervisor HOD/BM/RM/RSM/ZSM

Name : Name :

Signature : Signature :
 DA/ Tour Travel Shee
Name : Subrat kumar patra
Employee Code : IWS6594
Department : Deployment
SIEL Type : Outpar
Location : Bhubaneswar
Date : 9-May-19
Claims for the month : Apr-19

Destination/Place
Date
From To
(Dep. Time) (Arr. Time)

Self-driven - 4 wheeler Number & description : _____________________________________________________

HOTEL DETAILS
Location / Place City Category Check - In Date & Time Check - Out Date & Time No. of Days
Baripada C 02-04-2019& 4:00am 10-04-2019& 9:00Am 9

SAME DAY DAILY ALLOWANCES : 250* Days =

OVER NIGHT DAILY ALLOWANCES : 400* Days =

Employee Signature :
(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action agains

Checked & Approved by

Reporting Supervisor
Mr. Lalatendu Mohapatra
Name : Name :

Signature : Signature :
Tour Travel Sheet

Mode of
Purpose (Site visit, Other etc.) KMS Cost (Rs.) Remark if any
Travel

Total 0.00

________________________________________________________________
HOTEL DETAILS
Hotel Name Cost (Rs.) REMARKS
 HOTEL MAYURBHANJ

Total 0.00

- Total DA Cost : -

Total DA/ Tour Travel Cost -

take appropriate action against me )

ecked & Approved by

HOD/CH/GH/RH
 Conveyance - (Late sitting/ Weekend/ Holiday) & Food Expenses
Name : Sanjay Kumar Patri
Employee Code : IWS3660
Department : Quality
SIEL Type : Outpar
Location : Bhubaneswar
Date : 5-Nov-17
Claims for the month(s) of : Oct-17

Destination/Place Time Local

Purpose (Late sitting/ Mode of Total Hours @ Food Bill Cost
Date Kms Conveyance Lunch / Dinner
From (Complete add.) To (Complete add.) Weekend/ Holiday) Travel IN OUT [ HH:MM ] Rs.5 /km (Rs)
Cost (Rs)

Conveyance Total Food Bill Total 0.00

Total Cost
Employee Name

Associate Signature :
(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action against me )

Checked & Approved by HR Section

Reporting Supervisor HOD/BM/RM/RSM/ZSM

Name : Mr. Lalatendu Mohapatra Name :

Signature : Signature :
 Local Conveyance Log sh
Name : Subrat kumar patra
Employee Code : IWS6594
Department : Deployment
SIEL Type : Outpar
Location : Bhubaneswar
Date : 15-Sep-19
Claims for the month(s) of : Aug-19

Destination/Place
Date Purpose (Site visit, O
From (Complete add.) To (Complete add.)

Ganganagar
24-Aug-19 Nimapara Installation

Ganganagar
27-Aug-19 Brit collony Installation

Ganganagar
30-Aug-19 Pokhariput Integration

31-Aug-19 Ganganagar Pokhariput Alarm clearanc

Employee Name

Associate Signature :
(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action against me

Checked & Approved by

Reporting Supervisor

Name : Mr. Lalatendu Mohapatra

Name and sign of Area manager & above
Signature :
onveyance Log sheet
patra

Mode of Time @ Rs.5

Purpose (Site visit, Other etc.) Kms Total
Travel IN OUT /km

Bike 10:30am 5:00pm 100 5.00 500.00

Installation

Bike 10:30am 5:00pm 30 5.00 150.00

Installation

Bike 10:30am 5:00pm 20 5.00 100.00

Integration

Alarm clearance Bike 10:30am 5:00pm 20 5.00 100.00

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

5.00 -

Total 850.00
ake appropriate action against me )

& Approved by HR Section

HOD/BM/RM/RSM/ZSM

Name :
Name & sign of circle Head or mail approval
Signature :
 Other Expenses (Mobile)
Name : Subrat kumar patra
Employee Code : IWS6594
Department : Deployment
SIEL Type : Outpar
Location : Bhubaneswar
Claims for the month(s) of : 1-Jan-18

Sr. No. From TO Total

Mobile Expenses 26-Jan-19 25-Feb-19

Total -

Employee Name: Subrat Kumar Patra

Associate Signature :
(I hereby certify that the above claims are true and in case it is found to be false, the management can take appropriate action against me )

Checked & Approved by HR Section

Reporting Supervisor HOD/BM/RM/RSM/ZSM

Name : Mr. Lalatendu Mohapatra Name :

Signature : Signature :