THEMIS & KOPRAN PHARMACEUTICALS

Chemosyn

n
Super Distributors of
MONTH :- Oct-16

Email:zealindore@gmail.com

NAME : Dinesh Mishra

DATE :Da
te

Station
From

To
Station

EXPENSES STATEMENT MONTH OF OCT

Bus/
Train

K.
M

Tota
l
Fare

D.
A

M.
sc

Tot
all

Ord
er
valu
e

Total
Payment

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Addition/Deduction if any
Rs._________
Passed Amt
Rs._________________
RSB/ZSM Sign:

For OFFICE USE

ONLY
Total Passed
Rs_______________
Chq N0 &
Date________________

Submission Date
_____________
SIGNATURE:

A/C Manager Sign:

1. ALL CLAIM WITH BILLS SHOULD BE MENTIONED IN MISC,

Note:
COLUMN.
2. ALL THE COLUMN OF EXPENSES STATEMENT SHOULE IS FILLED
PROPERLY.

3. EXPENSES STATEMENT SHOULD REACH HEAD OFFICE BY 10 TH OF

EVERY MONTH.