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LSI India Research & Development Private Limited Application for house security deposit advance Name: Soumyajit

Roy Dept: CSD-Architecture Solutions Employee ID: Cost Centre: 00727770 367700

I would like to apply for an amount of Rs 100,000 (Rupees One Lakh only) for the purpose of furnishing a house security deposit advance. I have given Rs10000 as cash token money and I will pay him the rest Rs90000 on 5th June, 2012. I hereby authorize the company to deduct this advance in 24 equated interest free installments.

Yours Sincerely,

Employee Name: Soumyajit Roy

Signature: _________________________ Date: 4th June, 2012

Approved by: Name: ___________________________ Manager Name: ___________________________ HR Manager, India Signature: _________________________ Date: Signature: _________________________ Date:

* Perquisite tax will be levied as per the Income Tax regulations.

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