TRAVEL EXPENSE REIMBURSEMENT FORM

LODGING & BOARDING EXPENSES (A)

From Date To Date Accommodation Rent per
Booked by FCM / Self Amount Total Remarks
DD/MM/YY DD/MM/YY Type day
0

Total (A)
OTHER EXPENSES (B)
Expense Head Description, if any Amount Total Remarks
Luggage Transportation Expenses
Any other expenses Local Conveyance*
Total (B)
FINAL PAYMENT DETAILS
Total (A + B) I hereby declare that the information provided in this bill is
Less Advance Taken correct as the rules of the Company
Net payable to Company/ Employee

Rupees in words Claimant's Signature : __________________________

Approving
PERSONNEL & ADMIN / HR : ____________________ PM / HOD : ___________________________________
Authority

Passed for Rs. ________________________________________________________________________________

For HO/
Accounts Use Rupees in words ______________________________________________________________________________
Authorised Accounts Executive : __________________________________________________________________

All the claims should be as per travel policy and none of the employee can claim “daily allowance, out of pocket expenses” etc.