CLAIM FORM FOR TELEPHONE/MOBILE REIMBURSEMENT

NAME: Nishad Sultana DESIGNATION: Senior software engineer

DEPARMENT: IT EMPLOYEE NO: 2103

PAY LEVEL:

To
The Director
AIIA,
New Delhi - 110 076
11316
Kindly arrange to reimburse Telephone charges of Rs _______ , for the period*
2023 2024
from___________ to ________, details given below. The amount may be credited to
my bank account.

7026448843
Landline Telephone No.__________________ Mobile Phone No. _____________________

Month Billed Amount Total Claimed

Amount

Internet Landline Mobile

Dec 5800 16800
11000 15000

Total-Telephone Charges(A)

1. Certified that I have been/have not been provided with official telephone/internet at
my residence.
2. Certified that the above telephones are in my name.
3. Certified that I have incurred the above expenditure towards telephone charges
during the period mentioned above. Also certified I have not claimed Telephone
charges for reimbursement from other sources.

Nishad Sultana
Date: 16/06/24 Signature

*Claim should be submitted on quarterly basis starting from 1st April in each Financial Year.