EXPENSE REIMBURSEMENT FORM

ENTITY SSEPL Expense Period

Employee Name Prince Mittal From FEBRUARY 2019
Designation Senior Design Engineer To MARCH 2019
Department Design Engineering Project Details
Manager Name Vijayt Agarwal Name

Business Purpose Site Visit

Code

DATE DESCRIPTION CATEGORY RECEIPT(s) AMOUNT (INR)

VISIT AT S3 ENERGY FOR PROTO CHECK FOR CELEBI & ICAT
16-Feb-19 Sunsource Office to S3 Energy (25 km) Personal Vehicle- Bike Not Available 112.5
16-Feb-19 S3 Energy to Sunsource Office (25 km) Personal Vehicle- Bike Not Available 112.5
Site Visit at Pooja Forge, Faridabad
19-Feb-19 Sector 72 Noida to Noida city Center Metro Auto Fare Not Available 80
19-Feb-19 Noida Metro to Sarita Vihar Metro Metro Fare Not Available 40
19-Feb-19 Sarita Vihar Metro to Noida Metro Metro Fare Not Available 40
19-Feb-19 Noida Metro to Sector 72 Noida Auto Fare Not Available 80
Meeting at Sector 63 Noida with Let's Design
22-Feb-19 Sunsource Office to Sector 63, Noida (27 km) Personal Vehicle- Bike Not Available 121.5
22-Feb-19 Sector 63 Noida, to Sector 72 Noida Personal Vehicle- Bike Not Available 31.5
Site Visit at Kamdhenu, Kanpur
28-Feb-19 Water Bottle at Railway Station (3 People) Food Expenses Not Available 60
2-Mar-19 New Delhi railway Station to Noida Sector 72 Auto Fare Attached 376
Site Visit at ICAT, Extension, Manesar
7-Mar-19 Lunch (Prince + Anoop) Food Expenses Attached 400
Visit at Celebi Cargo, New Delhi
11-Mar-19 Sector 72, Noida to Noida City Centre Metro Auto Fare Not Available 70
11-Mar-19 Noida Metro to Terminal T1 Metro Metro Fare Not Available 50
11-Mar-19 Terminal T 1 Metro to Celebi Cargo, New Delhi Auto Fare Attached 123.37
11-Mar-19 Lunch at Celebi Cargo Food Expenses Not Available 150
11-Mar-19 Celebi Cargo, New Delhi to Termminal T1 Metro Auto Fare Attached 115.08
11-Mar-19 Water Bottle Food Expenses Not Available 40
11-Mar-19 Terminal T 1 Metro to Noida Metro Metro Fare Not Available 50
11-Mar-19 Noida City Metro to Sector 72 Noida Auto Fare Not Available 70
12-Mar-19 Sector 72, Noida to Noida City Centre Metro Auto Fare Not Available 70
12-Mar-19 Noida Metro to Terminal T1 Metro Metro Fare Not Available 50
12-Mar-19 Terminal T 1 Metro to Celebi Cargo, New Delhi Auto Fare Attached 120.36
12-Mar-19 Lunch at Celebi Cargo Food Expenses Not Available 150
12-Mar-19 Celebi Cargo, New Delhi to Termminal T1 Metro Auto Fare Attached 135.16
12-Mar-19 Water Bottle Food Expenses Not Available 40
12-Mar-19 Terminal T 1 Metro to Noida Metro Metro Fare Not Available 50
12-Mar-19 Noida City Metro to Sector 72 Noida Auto Fare Not Available 70
Visit at Bhilwara, Rajastan (For Sangam, Nitin & Manomay)
12-Mar-19 Sector 72 Noida to Noida city Center Metro Auto Fare Not Available 70
12-Mar-19 Noida Metro to Karol Bagh Metro Metro Fare Not Available 50
12-Mar-19 Karol Bagh Metro to Delhi Sarai Rohilla Railway Station Auto Fare Not Available 100
12-Mar-19 Water Bottle and Chips at Railway Station Food Expenses Not Available 100
13-Mar-19 Bhilwara Railway Station to Hotel Auto Fare Not Available 60
13-Mar-19 Cab to Manomay & Sangam Auto Fare Attached 1800
13-Mar-19 Toll Tax Miscellaneous Attached 80
14-Mar-19 Cab to Nitin Spinners and Sangam India Limited Auto Fare Attached 1700
14-Mar-19 lunch (Prince + Neerav + Amit Raj) Food Expenses Attached 680
15-Mar-19 Cab to Manomay and Sangam India Limited Auto Fare Attached 1900
15-Mar-19 lunch (Prince + Amit Raj) Food Expenses Attached 350
15-Mar-19 Dinner (Prince + Amit Raj) Food Expenses Attached 380
13-15 Mar, 2019 Hotel Stay and Food Expenses Hotel, Boarding & Lodging Attached 7977
15-Mar-19 Bhilwara to Delhi Bus Ticket Bus Ticket Attached 2098
16-Mar-19 Gurgaon to Noida Sector 72 (cab with Amit) Auto Fare Attached 745.36
Yakult Danone, Sonepat
26-Mar-19 Noida Sector 72 to Rohini (Prince + Surosh Sir) Auto Fare Attached 769.46

Sub Total 21667.79

Less Advance (if any) 0.00

21667.79
Total Reimbursement
*Attach Receipts

Declaration
I certify that the expenses cliamed here were incurred for official purpose and have not been claimed for or reimbursed elsewhere, and that the details provided are true.

Employee name & Signature Prince Mittal Date 28-Feb-18

Approver name & Signature Vijayti Agarwal Date 28-Feb-19

Checked and Verfified by (Admin) Date

Payment Processed by (Finance) Date

Additional Comments

Instructions for Claiming the Reimbursement

Please fill all the details carefully.
Give details about the expense category in description section.
For each expense, choose an appropriate category from the drop down list. If you have questions, get in touch with administration team.
Don't forget to attach copies of your receipts.
Keep a copy of your receipts and your reimbursement request form for your own records!
Please refer the Travel policy & ensure the expenses are in line with the same
Note:
The reimbursement forms with missing details, approvals won't be processed.
False or misleading information may lead to disciplinary action and may delay the payment for indefinite period.

Approval,
Mr. Kushagra Nandan/ Mr. Adarsh Das