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General Expenses Reimbursement

And Imprest Form


Employee Name:

Date of Claim:

Employee Code:
Band & Designation:

Location:
Corp. Function/ Business Unit:

Amount
Expenses Head

Particulars/Purpose
Rs.

P.

Telephone at Residence*
New Mobile Connection*
Mobile Handset*
Staff Welfare*
Relocation Expenses*
From__________To______________
Joining Expenses*
Printing & Stationary/ Photocopy
Postage/ Telegram/ Courier
Buss. Entertainment/ Business Gifts
Imprest / LTA Advance
Any other(1)

Any other(2)

Total(Rs.)
(in words)
Claimed by

Signature___________
Name______________
Date_______________

Verified by
HR/Admin.
Signature_____________
Name________________
Date_________________

Approved by
Received by
Business Head/ Corp. Func. Head
Signature___________
Name______________
Date_______________

Signature__________
Name______________
Date_______________

*to be verified by HR/Admin also

For Accounts:
Verified by______________

Amount To Be Disbursed (Rs)_____

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