TRAVEL EXPENSES CLAIM FORM

Name:- Romit Waikar Department: Amrut Pharmaciticul For Approval : (ZSM/FH): (Mention Any Remarks or note for approval)
Places visited:- Designation: So Reporting Manager :- ; NITIN PILE SIR
mployee Code: Grade: Head Quarter: Yavatmal
Period: 01/Nov/24 To 31-11-2024 Geography code: Date:-
Departure Arrival MARKET HQ/ Travel Distance Fare HQ EX with Bill / OS Local Special Remark TOTAL
WORKED EX/OS Conveyance Expenses
From Town Date Time To Town Date Time Mode Class KM
Yavatmal 01/Nov/24 Holiday 0.00
Yavatmal 02/Nov/24 Holiday 0.00
Yavatmal 03/Nov/24 WHF 0.00
Yavatmal 04/Nov/24 9:30 Yavatmal 04/Nov/24 18:30 Pimpalgaon road HQ BICK 230.00 230.00
Yavatmal 05/Nov/24 9:30 Pandharkawada parwa
05/Nov/24 18:30 Main market EX BICK 240 480 300 780.00
Yavatmal 06/Nov/24 mahagaon kali fulsawangi
9:30 06/Nov/24 18:30 Main market EX BICK 280 560 300 860.00
Yavatmal 07/Nov/24 leave 0.00
Yavatmal 08/Nov/24 SAWALI
9:30 SADOBA WAIBAJAR08/Nov/24
,MAHUR 18:30 Main market EX BICK 290 580 300 880.00
Yavatmal 09/Nov/24 9:30 YAVATMAL 09/Nov/24 18:30KALAMB CHOCK MARKET HQ BICK 230.00 230.00
Yavatmal 10/Nov/24 WHF 0.00
Yavatmal 11/Nov/24 9:30 wardha 11/Nov/24 18:30 Main market EX BICK 195 390 300 690.00
Yavatmal 12/Nov/24 9:30 wani 12/Nov/24 18:30 Main market EX BICK 285 570 300 870.00
Yavatmal 13/Nov/24GHATANI9:30
, PARWA,KURLI,GHOTI ,13/Nov/24
AKOLA BAJAR 18:30 Main market EX BICK 240 480 300 780.00
Yavatmal 14/Nov/24 9:30 DARWHA 14/Nov/24 18:30 Main market EX BICK 130 260 300 560.00
Yavatmal 15/Nov/24 9:30 UMARKED DHANKI15/Nov/24 18:30 Main market EX BICK 310 620 300 920.00
Yavatmal 16/Nov/24 RALEGAON
9:30 , DHANORA ,WADKI ,MARDI
16/Nov/24 18:30 Main market EX BICK 240 480 300 780.00
Yavatmal 17/Nov/24 WHF 0.00
Yavatmal 18/Nov/24 9:30 NER 18/Nov/24 18:30 Main market EX BICK 120 240 300 540.00
Yavatmal 19/Nov/24 leave 0.00
Yavatmal 20/Nov/24 9:30 ARVI 20/Nov/24 18:30 Main Market EX BICK 190 380 300 700 NIGHT STAY 1,380.00
Yavatmal SELOO,HINGANI,KELZAE,SINDHI
21/Nov/24 9:30 REILWAY,SEWAGRAM
21/Nov/24 18:30 Main market EX BICK 280 560 300 260 LUNCH 1,120.00
Yavatmal 22/Nov/24 9:30 ARNI 22/Nov/24 18:30 Main market EX BICK 155 310 300 610.00
Yavatmal 23/Nov/24 9:30 YAVATMAL 23/Nov/24 18:30 GODHANI ROAD HQ BICK 230.00 230.00
Yavatmal 24/Nov/24 9:30 WHF 0.00
Yavatmal 25/Nov/24 9:30 YAVATMAL 25/Nov/24 18:30 SBI CHOCK EX BICK 230.00 230.00
Yavatmal 26/Nov/24 9:30 PUSAD 1 26/Nov/24 18:30 Main Market EX BICK 160 320 300 620.00
PUSAD 27/Nov/24 9:30
SHEBALPIMPRI SHRIRAM27/Nov/24
PUR 18:30 Main market EX BICK 220 440 300 740.00
Yavatmal 28/Nov/24 9:30 DIGRAS 28/Nov/24 18:30 Main market EX BICK 205 410 300 250 MOBILE 960.00
Yavatmal 29/Nov/24 9:30 YAVATMAL 29/Nov/24 18:30 GODHANI ROAD EX BICK 230.00 50 sttatinery 280.00
Yavatmal 30/Nov/24 9:30 30/Nov/24
BABHULGAON, KALAMB, SAWARGAON 18:30 Main market EX BICK 140 280 300 100 courier 580.00

Weekly off, Office, Meeting, WFH Total 3680 7,360 1,150.00 5,100.00 0.00 0.00 1,360.00 14,870.00
Note: CLAIMANT: I hereby declare that By the HR/ Accounts Department Approved for Payment Reporting Manager Authorise Signature
particulars mentioned above are and the Signature
1. Do refer the TA DA Rule and fill the form Checked & Passed
expenses claimed are factual.
as per the eligibility and terms.
2. Mention Time in Hours: 01:00 hrs to 24:00
hrs. Don't use AM/PM.
3. Use the attached sheet (Other details) for
Local conveyance and Other expenses.
Signature Date Signature Date SIGN Date SIGN Date Signature Date
 Local Conveyance: (Enter the details for local conveyance including for using own vehicle)
Date From To Mode of Travel KM (for own vehicle) Amount

TOTAL 0.00

Other / Special Expenses (enter any other expenses with bill details and attach the bills)
Date Bill no Purpose Any Remarks Amount
8/3/2024 courier expences courier to shyam sir nagpur 30.00
8/13/2024 courier chaqe courier to raj pharma ( dipak aswami ) nagpur imp doc (DTDC) 100.00

TOTAL 130.00
Details of bills attached (enter any other expenses with bill details and attach the bills)
Date Particulars No of bills Any Remarks Amount

TOTAL 130.00