Sheet1Expense Claim Form ( ECF )NAME*Pavnish Kumar SharmaECN No.*8710LOCATION* (Please tick)JAICCN No.*ANALYSIS AND JUSTIFICATION OF EXPENDITURE(A) Give details of expenditure on the reverse of this claimPAYMENT(Please tick)& these expenses need authorisationDateLine Ref.Nature and Business Purpose Required for all ExpenditurekmsAmount(+) Supports be attachedCHEQUE PAY TO -----------------------------( Including names of customers/suppliers/employees if applicable)Rs.For further information on completion see page-2-------------------------------SL.COMPUTERRS.1-NovHome toVidyadhar Nagar, Tonk Road, C-SchemeNO.EXPENDITURECODEPl round off to nearest Re2-NovHome toM.I.Road, Tilak Nagar1MEDICAL- Monthly Reimbursement for self & dependents(+)5-NovHome toSanaganer, Gopalpura, Indira Bazar, Station Road2PETROL - Montly Reimbursment(+)6-NovHome toAjmeri Gate, Film Colony, Ajmeri Gate, Raja Park3DRIVER - Monthly Reimbersment(+)7-NovHome toAjmer Road, M.I.Road, Ajmeri Gate4TAXI HIRE CHARGES(A)+8-NovHome toSanaganer, Amabari, Vidyadhar Nagar, Station Road, M.I.Road5VEHICLE MAINT - for Co. Vehicles(A)+9-NovHome toFilm Colony, Raja Park, Jawahar Nagar, Tonk Road, Subhash Nagar6CONVEYANCE - Monthly Reimbursement(A)+529415-NovHome toVidyadhar Nagar, Khatipura Road, Vaishali Nagar,7LOCAL CONVEYANCE / TRANSPORTATION / FREIGHT/ OCTROI(A)+16-NovHome toSanganer, Ajmer Road, Tonk Road, Station Road8STAFF WELFARE - Refreshment & Goods for staff only(A)+19-NovHome toSanaganer, Tonk Road, C-Scheme, M.I.Road9PRINTING & STATIONARY For office use only(A)+20-NovHome toM.I.Road, Ajmer Road10PURCHASE SERVICES / CASUAL LABOUR(A)+21-NovHome toVidyadhar Nagar, M.I.Road, Ambabari, Chandpole11GIFT & PRESENTATION (Please provide name of giftees)(A)+22-NovHome toM.I.Road, Station Road,12BUSINESS PROMOTION / ENTERTAINMENT (Pls. provide Entertainment Expenditure Declaration Form)(A)+23-NovHome toChandpole, Janta Bazar, Johri Bazar, C-Scheme26-NovHome toSanaganer, Prithwiraj Marg, C-Scheme, M.I.Road, Raja Park13MEETING/CONFERENCE/SEMINAR(A)+27-NovHome toBani Park, Station Road14BOOKS & PERIODICALS FOR OFFICE(A)+28-NovHome toSanaganer, Tonk Road, M.I.Road, Malviya Nagar15MEMBERSHIP & SUBSCRIPTION(A)+29-NovHome toVidyadhar Nagar, Sikar Nagar16TELEPHONE/MOBILE(A)+120030-NovHome toSanaganer, Amabari, Vidyadhar Nagar, Station Road, M.I.Road17REPAIRS & MAINT. - Renovation & Repairs(A)+18COURIER CHARGES - Local courier/cases delivery person etc.(A)+19POSTAGE & TELEGRAM(A)+20LEGAL/PROFESSIONAL CHARGES(A)+21DEVELOPMENT CHARGES(A)+22PHOTOCOPYING CHARGES(A)+23AUDITORS OUT OF POCKET EXPENSES(A)+24IMPREST(A)+25OTHERS PLS SPECIFYParking(A)+AActual mobile bill amt1250TOTAL AMOUNT CLAIMED6494.0Bless part of salary0LESS: IMPREST / ADVANCE TAKEN0Cless personal calls50BALANCE DUE ( TO ) FROM COMPANY0DBalance:(A-B-C)1200AMOUNT IN WORDSSix thousand four hundred ninty four only.Eeg:-as per dsgnt USAGE LIMIT1500Balance:(D-E)-300AMOUNT PASSED BY ACCOUNTSTotal Claim1200Please ensure that approval signatories are confirming compliance to approval authority policy.Claimant's Signature*Approval Signature*Special ApprovalChecked by Accounts DeptName: Pavnish Kumar SharmaNameNameCash Received byDate: 1 Dec 2012DateDateSignature

Kindly affix Revenue Stamp, if payment exceeds Rs. 500/-

Sheet2

Sheet32-DecHome to AirportSanganer, Malviya Nagar, Indira Bazar3-DecHome to AirportSanganer, Station Road, Bani Park4-DecHome toC-Scheme, M.I.Road, Murlipura5-DecHome tosubhash Nagar & Back7-DecHome to AirportSanganer, Tonk Road, M.I.Road8-DecHome to AirportSanaganer, Station Road, Civil Lines, C-Scheme9-DecHome to AirportSanganer. Tonk Road, C-Scheme10-DecHome to AirportSanganer, M.I. Road11-DecHome to AirportSanganer, Tonk Road, M.I.Road12-DecRiya TravelM.I.Road, Nehru Bazar, Jawahar Nagar14-DecHome to AirportSanganer, Durgapura, Devi nagar, Nirman nagar15-DecHome to AirportSanganer, S.C.Road, M.I.Road16-DecHome to AirportSanganer, station road, chandpole, C-scheme17-DecHome to AirportSanganer, hawa sarak, Ajmer Road18-DecHome to AirportSanganer, C-scheme, Tonk Road, Subhash nagar19-Dec21-DecSri Balaji AssociatesSikar Road, Murlipura, V.K.I, Vidyadhar22-DecShiv EnterprisesChand Pole Gate, Indira Bazar, S.C.Road23-DecHome to AirportSanganer, M.I.Road,24-DecHome to AirportTonk Road, Bapu nagar28-DecDiana TravelStation Road, M.I.Road, Bani Park29-DecHome to AirportSanaganer, Raja Park, Tilak Nagar30-DecRiya TravelM.I.Road, Johri Bazar31-DecON LEAVE