For HO Use :

Reimb No. : __________________________

Acc Dept Sign & Date : __________________________

EXPENSE REIMBURSEMENT STATEMENT

Date:______________ Period From: _________ To _________

Base Location : ___________________________

Employee Name : Employee code :

Department : Project Name : Circle: Project Code :

Supportings
SN Details of Expenses Amount Total Amount Bill Voucher
1 Daily Allowance Rs.
2 Hotel Expenses Rs.
3 Telephone calls / Fax Rs.
4 Internet Services Rs.
5 Courier/Postage/Telegram: Rs.
6 Travel Expenses :
(a) Air Rs.
(b) Train Rs.
(c) Car/Bus/Taxi Rs.
(d) Auto Rickshaw Rs.
Total Travel expens Rs.
7 Stationery Expenses :
(a) Battery/Cell Rs.
(b) Photocopy Rs.
(c) Others Rs.
Total Stationary expenses Rs.
8 Miscellaneous Expenses:
(a) Amt Given to Admin for Cab Hire Rs.
(b) Rs.
(c) Rs.
(d) Rs.
Total Misc. expenses Rs.
Grand Total No of Supp.

Advance Taken : Rs._________ Less This Statement: Rs._________ Balance left/claim: __________________

Employee's : Sign & Date Verification by : Name, Sign & Date

Supervisor' Name, sign & Date

Metro Wireless Engineering (India) Pvt. Ltd. - Strictly Confidential

For HO Use :

Reimb No. : __________________________

Acc Dept Sign & Date : __________________________

Verification at HO by : Finance Director Sign

Metro Wireless Engineering (India) Pvt. Ltd. - Strictly Confidential