CLAIM FORM FOR TELEPHONE REIMBURSEMENT

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

To,
Payroll Section
ONGC Petro additions Limited
Vadodara.

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

Landline Telephone No. ……………………………… Mobile Phone No. …………………………

Month Billed Amount Total Claimed Amount
(Max. Rs. 2000* p.m.)
Landline Mobile

Total-Telephone Charges (A)

Broadband Charges:

Total-Broadband (B)
Grand Total (A+B)
* Applicable where Company has not provided any telephone connection.
1. Certified that I have been/have not been provided with any telephone connection at my residence.
2. Certified that the above telephones are in my name or my dependents at my current residential
address.
3. Certified that no Security Deposit/Installation charge is being claimed.
4. Certified that I have incurred the above expenditure towards telephone charges during the period
mentioned above. Also certified that no other claim will be claimed for reimbursement from other
sources.
5. Enclose Invoices in Original.

Date: Signature: