Application form for reimbursement of expenditures

Form for claim of reimbursement of entertainment expenses for official purposes other than incurred in a club.

Name :
Designation : Grade/Scale
Grade/Scale :
Employee No. :
Period :
Certificate Basis
Voucher Basis Charges a/c Entertainment (tea, coffee & snacks)

I certify that Rs. (Rupees ) was incurred by me wholly and exclusively in the performance of my official duty on entertainment, which may please be reimbursed to me as per my entitlement.

Date
Place Signature of the Official

SANCTIONING AUTHORITY REMARKS

I have perused the above form, the declaration given by Smt./Shri ………………………………. and the original bills in support of the expenditure incurred. On that basis, it is certified that the above expenditure was incurred by Smt./Shri ……………………….. (name of the officer) wholly and exclusively in the performance of his official duty. Passed for the payment for Rupees _________________________________________ .

For

ã䪶ããâ‡ãŠ Date :
¹ãƺãâ£ã‡ãŠ /Manager

FOR OFFICE USE
Debit Charges A/C Credit (1) Banker Cheque
Rs._______________ Rupees _______________________________________________________
Bill Scrutinised and found in order

Manager Date :