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200
400 300 500 1900
(Auto Fare)
Date
Total Long Distance / Bus / Train / Air Particulars paid by Co. Paid by me 10/21/2013 Bangalore to Bhubaneswar 1822.47 7/18/2013 Bhubaneswat to Puri (Ticket Enclosed)
7/19/2013 Puri to Kolkata 7/26/2013 Howrah to Bangalore
(Ticket Enclosed)
1,717.47
480.00
16,462.00
Prepared by
Checked by
Authorised by HOD
Date:
BUS - AUTO FARE Conveyance for the month of ...Date ... Name ....Designation Dept
Date
From
To
Amount
Purpose of Visit
PREPARED BY
VERIFIED BY
AUTHORISED BY
Name ------------------ Designation --------------------- Dept ------------------------Vehicle Reg. No Make of Vehicle Contact Number
(Strike out whichever is not applicable) (1) Four Wheeler/Two Wheeler (2) Company Provided/Own Vehicle
Date
Place of Visit
Starting KMS
Closing KMS
Purpose of Visit
I hereby certify that Vehicle details and the Kms mentioned above are actually travelled by me on official works.
Signature of HOD:
Signature Of Employee:
6080
6,080.00
Date
Paid by me
55,055.00
Prepared by
Checked by
Authorised by HOD
Date: