S.

No Particulars Data

1 Name of the Company

2 Load Date

3 Tank Truck No.

4 Load No.

5 Invoice No.

6 Origin

7 Destination

8 Driver Name

9 Helper Name

10 Advance Amount - Driver

11 Advance Amount - Helper

12 Toll Amount Claimed

13 Other Expenses

14 Balance with Driver

15 Available Diesel Balance

16 Diesel Topup Quantity

17 Place of Diesel Topup

18 Diesel Rate

19 Total Diesel Amout

20 Mode of Payment Details

21 Remarks (if any)

Driver Signature