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Vehicle Conveyance

This is a vehicle expenses reimbursement form for an employee to claim mileage reimbursement. It requests information such as the mode of conveyance used, dates of travel, distances traveled from and to locations, and purposes of the trips. The employee and supervising authority must sign to certify the expenses were for official purposes. Reimbursement rates are provided based on type of vehicle and fuel used.

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Vinay Singh
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2K views1 page

Vehicle Conveyance

This is a vehicle expenses reimbursement form for an employee to claim mileage reimbursement. It requests information such as the mode of conveyance used, dates of travel, distances traveled from and to locations, and purposes of the trips. The employee and supervising authority must sign to certify the expenses were for official purposes. Reimbursement rates are provided based on type of vehicle and fuel used.

Uploaded by

Vinay Singh
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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Company Name :

VEHICLE EXPENSES REIMBURSEMENT FORM


I declare that the below vehicle expenses were incurred by me exclusively in the performance of my official duties. MODE OF CONVEYANCE : OWN / COMPANY PROVIDED MILEAGE : DATE Purpose DISTANCE FROM

TO

Kms. Rate AMOUNT Rs.

Total (Rupees : __________________ ) Rate : Rs.4/- per Km for Car running on diesel Rs.7/- per Km for Car running on petrol Rs.2.50/- per KM for 2 wheelers Signature of the claimant: Name of the claimant : Designation : Department : Certification by supervising authority : Yes, the above vehicle expenses were incurred for official purposes

Signature of the approving authority (HOD) Name of the Supervisor :

Signature of the C.E.O.

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