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START UP FARMS IT PRIVATE LIMITED CHANDIGARH

MEDICAL EXPENSE CLAIM FORM Name ABHISHEK AGNIHOTRI Ecode E097 Division Alert/STI/SUFI Designation: MANAGER Pls allow reimbursement of medical expenses incurred as per details below: Expense for Name of the Doctor/Chemist Self/Dependant Bill No.

Date

Amount

TOTAL Rupees in Words : Declaration :


I hereby declare that the particulars furnished are true to the best of my knowledge and belief and also undertake that in case the above reimbursement claim is found to be inappropriate, I undertake to refund the said claimed amount & also liable for payment of income tax rebate claimed/penalty on this account.

Date :

Signature of Claimant

All bills are to be submitted in original.

START UP FARMS IT PRIVATE LIMITED CHANDIGARH


TELEPHONE EXPENSE CLAIM FORM Name Ecode Division Designation: ABHISHEK AGNIHOTRI E097 Alert/STI/SUFI MANAGER Telephone/ Month Amount INR Mobile Number APRIL 9467809143 MAY 9467890143 JUNE 9467809143 JULY 9467809143 AUGUST 9467809143 SEPT 8950575539 OCTOBER 8950575539 NOVEMBER 8950575539 DECEMBER 8950575539 JANUARY 8950575539 FEBURARY 8950575539 MARCH 8950575539

Particulars BSNL POST PAID PHONE BSNL POST PAID PHONE BSNL POST PAID PHONE BSNL POST PAID PHONE BSNL POST PAID PHONE TATA DOCOMO DONGEL TATA DOCOMO DONGEL TATA DOCOMO DONGEL TATA DOCOMO DONGEL TATA DOCOMO DONGEL TATA DOCOMO DONGEL TATA DOCOMO DONGEL TOTAL Rupees in Words : Four thousand One hundred eighty six rupees only

426 311 305 210 378 308 843 281 843 281

4186

Declaration : I hereby declare that the particulars furnished are true to the best of my knowledge and belief and also undertake that in case the above reimbursement claim is found to be inappropriate, I undertake to refund the said claimed amount & also liable for payment of income tax rebate claimed/penalty on this account.

Date :

10th feb 2014

Signature of Claimant

START UP FARMS IT PRIVATE LIMITED CHANDIGARH


Vehicle Running and Maintenance Expenses Claim Form Name Ecode Division Alert/STI/SUFI Designation: Pls allow reimbursement of Vehicle running and maintenance expenses incurred as per details below: Particulars of Invoices Fuel/Maintenance Bill No. Date Amount

TOTAL Rupees in Words : Declaration :


I hereby declare that the particulars furnished are true to the best of my knowledge and belief and also undertake that in case the above reimbursement claim is found to be inappropriate, I undertake to refund the said claimed amount & also liable for payment of income tax rebate claimed/penalty on this account.

Date :

Signature of Claimant

All bills are to be submitted in original.

START UP FARMS INDIA PRIVATE LIMITED CHANDIGARH


LTA REIMBURSEMENT CLAIM FORM EMP Name: Mr./Ms. Designation: Date of Joining : From Period of Leave Claim of Expenses : Travel Dates From To From Place of Visit To Mode / Name of Transportation Amount To No. of Days No. of members accompanied : Name

Relation

TOTAL Rupees in Words : Declaration : I hereby declare that the particulars furnished are true to the best of my knowledge and belief and also undertake that in case the above reimbursement claim is found to be inappropriate, I undertake to refund the said claimed amount & also liable for payment of income tax rebate claimed/penalty on this account.

Date : FOR HR DEPTT. / FINANCE DEPTT. No. of Days leave marked From To LTA claim Amount LTA passed for

Signature of Claimant

HR Deptt.

Accounts Deptt.