Travel Reimbursement Form

Employee Name: Archit Choudhry Travel Period

Employee ID: SR002692 From: 01-08-2020
HOD Name: Adrita Nag To: 31-08-2020
Department: North Zone

Mode of Travel COST OF

Sr No. Type of Travel Date of Travel From To KMS
(Metro, Auto, Car) TRAVEL

1 Lateral Movement 1-Aug-2020 Home Shalimar Bagh Car 8 80

2 Lateral Movement 1-Aug-2020 Shalimar Bagh Home Car 8 80
3 Lateral Movement 2-Aug-2020 Home Rohini 3 Car 11 110
4 Lateral Movement 2-Aug-2020 Rohini 3 Rani Bagh Car 4.7 47
5 Lateral Movement 2-Aug-2020 Rani Bagh Rohini 3 Car 4.8 48
6 Lateral Movement 2-Aug-2020 Rohini 3 Rohini 7 Car 1.9 19
7 Lateral Movement 2-Aug-2020 Rohini 7 Shalimar Bagh Car 6.4 64
8 Lateral Movement 2-Aug-2020 Shalimar Bagh Home Car 8 80
9 Lateral Movement 5-Aug-2020 Home Adarsh Nagar Car 10 100
10 Lateral Movement 5-Aug-2020 Adarsh Nagar Home Car 11 110
11 Lateral Movement 6-Aug-2020 Home Parmanand Colony Car 10 100
12 Lateral Movement 6-Aug-2020 Parmanand Colony Home Car 13 130
13 Lateral Movement 7-Aug-2020 Home Rohini 7 Car 10 100
14 Lateral Movement 7-Aug-2020 Rohini 7 Rohini 11 Car 5 50
15 Lateral Movement 7-Aug-2020 Rohini 11 Home Car 14 140
16 Lateral Movement 8-Aug-2020 Shastri Nagar Rani Bagh Car 7.7 77
17 Lateral Movement 8-Aug-2020 Rani Bagh Shalimar Bagh Car 4.7 47
18 Lateral Movement 8-Aug-2020 Shalimar Bagh Home Car 8 80
19 Lateral Movement 9-Aug-2020 Home Shalimar Bagh Car 8 80
20 Lateral Movement 9-Aug-2020 Shalimar Bagh Rohini 7 Car 7.5 75
21 Lateral Movement 9-Aug-2020 Rohini 7 Shastri Nagar Car 9.2 92
22 Lateral Movement 13-Aug-2020 Home Adarsh Nagar Car 10 100
23 Lateral Movement 13-Aug-2020 Adarsh Nagar Home Car 11 110
24 Lateral Movement 14-Aug-2020 Home Rohini 3 Car 11 110
25 Lateral Movement 14-Aug-2020 Rohini 3 Shastri Nagar Car 10 100
26 Lateral Movement 16-Aug-2020 Home Rohini 7 Car 10 100
27 Lateral Movement 16-Aug-2020 Rohini 7 Shalimar Bagh Car 6.4 64
28 Lateral Movement 16-Aug-2020 Shalimar Bagh Home Car 8 80
29 Lateral Movement 18-Aug-2020 Home Kamla Nagar Car 6.6 66
30 Lateral Movement 18-Aug-2020 Kamla Nagar Adarsh Nagar Car 5.7 57
31 Lateral Movement 18-Aug-2020 Adarsh Nagar Rohini 11 Car 8.7 87
32 Lateral Movement 18-Aug-2020 Rohini 11 Prashant Vihar Car 3.5 35
33 Lateral Movement 18-Aug-2020 Prashant Vihar Rani Bagh Car 3.9 39
34 Lateral Movement 20-Aug-2020 Home Rohini 3 Car 11 110
35 Lateral Movement 20-Aug-2020 Rohini 3 Home Car 12 120
 (DD/MM/YYYY)
(DD/MM/YYYY)

Daily Travel Cost

Actual Cost
(Home to base clinic and
Column I Minus Column J)
back )

55 25
55 25
55 45
47
48
19
64
55 25
55 45
55 55
55 45
55 75
55 45
50
55 85
77
47
55 25
55 25
75
92
55 45
55 55
55 55
100
55 45
64
55 25
55 11
57
87
35
39
55 55
55 65
 36 Lateral Movement 25-Aug-2020 Home Rohini 7 Car 10 100
37 Lateral Movement 25-Aug-2020 Rohini 7 Rohini 3 Car 2.6 26
38 Lateral Movement 25-Aug-2020 Rohini 3 Home Car 10 100
39 Lateral Movement 26-Aug-2020 Home Shalimar Bagh Car 8 80
40 Meeting in Yarrow Lab (bio 26-Aug-2020 Shalimar Bagh Yarrow Lab Car 31 310
38 Lateral Movement 26-Aug-2020 Yarrow Lab Home Car 27 270
38 Lateral Movement 27-Aug-2020 Home Parmanand Colony Car 10 100
38 Lateral Movement 27-Aug-2020 Parmanand Colony Shalimar Bagh Car 8.2 82
38 Lateral Movement 27-Aug-2020 Shalimar Bagh Home Car 8 80
38 Lateral Movement 28-Aug-2020 Rani Bagh Shastri Nagar Car 6 60
38 Lateral Movement 29-Aug-2020 Home Parmanand Colony Car 10 100
38 Lateral Movement 29-Aug-2020 Parmanand Colony Rohini 11 Car 13 130
38 Lateral Movement 29-Aug-2020 Rohini 11 Home Car 14 140
38 Lateral Movement 30-Aug-2020 Home Rohini 7 Car 10 100
38 Lateral Movement 30-Aug-2020 Rohini 7 Adarsh Nagar Car 9.7 97
38 Lateral Movement 30-Aug-2020 Adarsh Nagar Home Car 11 110

Approver Signature Date - 6th Sept 2020

Note: All reports and supporting (bills, receipt of payments etc.) to be authorized as per approval matrix defined.

Pay cycle due date:

Reimbursements received Due date
By 5th of every month 20th of the month
By 20th of every month 5th of next month
Note: In case any of the date mentioned above is Non-working day/Company Holiday, next working day will be considered for processing.
 55 45
26
55 45
55 25
310
55 215
55 45
82
55 25
60
55 45
130
55 85
55 45
97
55 55
Total 3112