TVS LOGISTICS SERVICES LIMITED

Reimbursement Claim Form

Name : KANNAN K E Code : 033654

Designation : MANAGER Claim ID : TVS-007828-RMB

Work Location : TVSLSL OFFICE Claim Date : 15 Jul 2015

Bank A/C No : 056501501457 Claim Status : Pending Authorization

Reimbursement Item Bill No Bill Date Name of the Relationship Claim Value
beneficiary with the
employee

Mobile Reimbursement 274141597 Self Employee 750.00

Signature of the employee Total Claim Amount: 750.00

For office use only

Entitlement per year : Rs.__________ Balance amount eligible : Rs._____________

Availed till date : Rs._________ Amount passed for payment: Rs.____________

Signature of the passing authority (HR)