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COMPANY NAME

Telephone Reimbursement Claim Form for 2020-21

Employee Name: Employee Code:


Company Name: Department:
Designation: Claim Date:

Non- Taxable Telephone Reimbursement

S. No Name Mobile No. Bill No. Bill Date Bill Bill Details/
Amount Remarks

Total Non- Taxable Telephone Bills amount

I, ___________________________, do hereby declare that the aforesaid information is true and correct to the best of my
information and belief. I further declare that I shall indemnify the company against all costs and consequences if
any information is later on found to be incorrect.

Employee Signature Date:

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