CLAIM FORM FOR NEWSPAPER REIMBURSMENT

NAME: DESIGNATION:
DEPARTMENT: EMPLOYEE NO:
LOCATION: MOBILE NUMBER:

To,
Payroll Section
ONGC Petro additions Limited
Vadodara.

Kindly arrange to exempt newspaper bills of Rs. ______________ for the period from
_________________ to __________________ details given below. The amount is being paid along
with the monthly salary & as per declaration given.

Newspaper Name (1). ……………………… Newspaper Name (2). …………………

Month Billed Amount Total Claimed Amount
(Max. Rs. 1000* p.m.)

Total-Newspaper Reimbursement (A)

* Applicable where Company has not provided any similar benefit (OCR etc.)

1. Undertaking I hereby declare that the above bill/amount indicated in this bill & claimed above has
not been claimed earlier at any time.
2. Enclose Invoices in Original.

Date: Signature