Reimbursement Number : LTA/2017/2427

Submitted Date : 08/29/2017

Leave Travel Assistance Form

Name Sazeena Devi Emp Code 20172

Designation TRAINEE PROGRAMMER ANALYST Department

Location GDC Chennai - MEPZ Date of Joining 08/01/2016

Date of Last Claim Company HTC Global Services

Leave Availed From Leave Availed Until

Bill Details
From Date Travelled From To Date Travelled To Ticket Number Amount (in INR) Approved
Amount (in INR)

Total 8853.00 0.00

Total approved amount 0.00

Peroson('s) Travelled Details

Name Age Relationship Remarks

I hereby declare that the above expenditure is incurred by me as per the policy of the company towards fare for travelling for self/my
dependent/s(as explained ) and that the contents of the above claim are true and correct to the best of my knowledge. I understand that all the
tax applications arising out of this claim shall be borne by me.

______________________ ______________________

Employee Signature Date