MEDICAL EXPENSES FOR THE YEAR 2018-2019

Medical Expenses Details

Employee Name : Rabindra Kumar Paltasingh

Employee No : 323222
Date of Joining : 9-Jan-18
Designation : Technical Lead

DATE BILL/INVOICE NAME OF PERSON RELATIONSHIP AMOUNT

OF BILL NUMBER FOR WHOM INCURRED WITH EMPLOYEE Rs.
ICR54573
25-Nov-18 ISP52878 PRANATI RAUTARAY SPOUSE 17,526
23-Nov-18 CS1862068 PRANATI RAUTARAY SPOUSE 600
17-Nov-18 46923 PRANATI RAUTARAY SPOUSE 2,100

GRAND TOTAL Twenty Thousand Two Hundred Twenty Six 20,226

NOTE : Please attach all relevant supporting evidences.

Place: Bangalore

Date: 31-Jan-19 EMPLOYEE SIGNATURE

I hereby declare that I have incurred the above expenditure in my official capacity and in the course of discharging my responsibilities as an employee.
I hereby declare that what is stated above is true to the best of my knowledge and belief.

Note: Kindly use this template for claiming Medical exemption benefit