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Fitness'n'Spa
OZONE SPA PVT LIMITED, M-91/132, CONNOUGHT CIRCUS, NEW DELHI-110001.

CONVEYANCE CLAIM BILL

BRANCH: ____________________________ Date: __________

Name: Designation/Rank:
Department: Employee Code:

I hereby confirm & certify that I have incurred following expenses on conveyance for company’s work
under instructions of Name:_________________________________Designation: ___________________
I request you to kindly reimburse me the same.
Employee movement register, entry serial number is: _______________________________________ .

Mode of transport: By Air/Train/Bus/Taxi/Car/Three wheeler/Rickshaw/Two wheeler/Any other.

Date Destination Destination Purpose in Brief Total Amount Total
From To KMs @ Amount

Total Claim Amount:

Note : This form may also be used for claiming miscellaneous expenses incurred.

Date of Claim :…………………………… Signature:…………………………………

For office use:

Signature of verifying authority: ______________
Name of verifying authority:__________________
Received Rs………………………
Sanctioning Authority:

Account Head
Employee’s Signature
Date: