Expenses Claim Form
Date 13.12.2023 SI. No.
From 13.12.2023 To 13.12.2023
Name Department Employee Code Cost Centre No.
Abhineet Kr. Tiwary Finance VXT2235 69540
Claimable With Amount
Particulars Bill No. Account No.
Supporting Bills Rs. P.
Speed Post Charges Yes - 130 0
Total: Rupees One Hundred Thirty Only 130 0.00
Note: All the above expenses are in accordance with entitlement.
Claimant Checked By Approved By
TRAVEL EXPENSES ANNEXURE 6.5.1 Doc Code
STATEMENT Doc No.
Date
To be filled by accounts
Name Emp. No. Grade Sale Order No. Cost Centre TI No.
69540
Purpose of visit
Date Total
Departure Place
Time
Arrival Place
Time
Tickets By Co.
Purchased By Self
Accommodation Allowance/
Actual
Food Allowance/Actual
Location Days Amount Conveyance Expenses (give details in column (CX) below)
Out of Pocket Expenses (Days x Rate)
Telephone (exclude from Hotel Bill)
Entertainment Expenses
Minral Water
TOTAL EXPENSES (T)
CX Date From To Mode Amount ADVANCE DETAILS
A Location Ticket No. Amount
TICKET
BY
CO.
B Location Ticket No. Amount
CASH
ADV.
C Location Ticket No. Amount
CREDIT
CARD
Total Advance D=A+B+C
Amount due to Company (D-T)
Total (CX) Amount due from Company (T-D)
Payment Voucher
Signature Date Received the balance amount of Rs.
Employee
Checked by
Approved by Signature of Employee
All amounts in Rupees Round off fractions to nearest rupee Copies to : Accounts
Cashier
** Use additional sheet if required
File
SERVICE PROVIDER AGREEMENTS STATUS
Contractor Purpose Start Period End period Remarks
Housekee
Vema
ping 3/22/2022 3/21/2023 PO No - 2010001345
Hospitality
Agency
Security
SIS Security 3/22/2022 3/21/2023 PO No - 2010001346
Services
Sujeet Singh Transport
3/22/2022 3/21/2023 PO No - 2030001143
Rathore er
Dev Mata
Car Rental 3/22/2022 3/21/2023 PO No - 2030001528
Travels
Geo
Buildcon Korba WS
5/15/2021 5/14/2026
Private Rent
Limited
Shri Ram
Canteen 3/22/2022 3/21/2023 PO No - 2010001347
Hotel
Mamta Drinking
3/22/2022 3/21/2023 PO No - 2010001348
Industries Water
Safexpress Freight PO No - 2030002484
Pvt Ltd 7/1/2023 6/30/2023
MENTS STATUS
Remarks as on today
Form-B raised on 20.04.2023, HR head
approval pending
Form-B raised on 20.04.2023, HR head
approval pending
Form-B for new agreement Under
Process
Currently no transactions with this
Vendor
Invoice processing by HO w/o PO
Form-B raised on 19.04.23 Approved
forwarded for PO
Form-B raised on 19.04.23 Approved
forwarded for PO
PO valid for 01.07.2022 to 30.06.2023
