( Company Name )
TELEPHONE / INTERNET REIMBURSEMENT FOR THE MONTH ……………………..

(Please ensure that no column is left blank. Incomplete Forms will not be entertained)

(To be submitted before ---- of every month Bills submitted after ----- of the month will be considered for payment along with next month's salary)

*Telephone / Internet Reimbursement Claims can be made on a monthly basis against bills (Recharge on Prepaid numbers will not be entertained). Unclaimed amount shall be paid as allowance at the end of the year and taxed.

NAME :

EMPLOYEE CODE:

ZONE:

DESIGNATION:

FUNCTIONAL AREA:

BRANCH:

DATE:

DEPARTMENT:

BASE STATION:

TELEPHONE / INTERNET EXPENSE DETAILS

BILL / CASH MEMO

SN

NO.	DATE

TELEPHONE / INTERNET EXPENSES DONE FOR
(NAME OF THE PERSON*)

RELATIONSHIP WITH EMPLOYEE

AMOUNT

SERVICE PROVIDER DETAILS

Rs.	Paise

	

	

SIGNATURE OF THE EMPLOYEE:

FOR HR RECORDS AND ACTION

TELEPHONE / INTERNET REIMBURSEMENT AMOUNT PASSED FOR: Rs. ……………………………... /-

SIGN:

AUTHORIZED BY HR	DATE: