COMPANY LIMITED

BRANCH OFFICE

CLAIM FOR REIMBURSEMENT OF MOTOR CAR RUNNING EXPENSES

FOR THE MONTH OF APRIL 2010
Name of the Officer: Designation: Branch Manager
Car No. Date of Purchase: Place of Posting:
Meter Reading at opening of the month: 1 Running during the month 99
Meter Reading at close of the month: 100
Petrol charged for TE bills for the
A. RUNNING EXPENSES: month
Cost 0
Allowable
Cash/Me
Date of mo Qty. Rs. Rs.
Purchase Number Name of the Dealer Litres. Ps. Ps.

B. SERVICE CHARGES: Allowable

Cash/Me Cost
mo Name of the Dealer Rs. Rs.
Date Number Ps. Ps.
(cleaning charges) 200.00
Less: Petrol Chargeable for TE Bills 0 #DIV/0!
Enclosures:
PREVIOUS PETROL BILLS
REIMBURSEMENT PARTICULARS IN THE TOTALS 0.00
TOTAL REIMBURSEMENT #DIV/0!
(A+B)
PRESENT QUARTER Rs.
MONTH QUANTITY AMOUNT

NAME: XYZ
TOTAL DATE: DESIGNATION
FOR OFFICE USE:
Passed for payment for
AMOUNT AMOUNT Rs. Rs.____
PAID

DATE: authorised official

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