Genius Consultants Limited

Associate Deployed at: Dalmia Cement Bharat Limited

REIMBURSEMENT CLAIM FORM

Claim for the Month of: SEPTEMBER 2023
Name : INZEMAM UL HAQUE ZAHEER UL HAQUE Employee ID : AEMP001544000379
Designation : Jr. Technical Service Executive Claim Period: 1/9/2023 TO 30/9/2023
Department : Technical Department

Expense Details Amount No. Of Bills Attached

Lodging :

Fooding:

Fixed Monthly Expense : 3925

Local Conveyance : 6100.5

Out-Station Local Conveyance :

Ticket :

Telephone/ Mobile Recharge 302

(incl. Data usage)

Others :
(Other expenses includes
Stationary, Postage, Parking
Charges, General expenses)

Total Amount : 10327.5

Signature of Associate :

Signature of Client (Dalmia Cement Bharat Limited) :

Signature of Branch Head (Genius) :

 CONVEYANCE EXPENSE STATEMENT & FIXED MONTHLY EXPENSE STATEMENT
Claim Period : From: 1/9/2023 ______ To: 30/9/2023 ______

NAME : INZEMAM UL HAQUE ZAHEER UL HAQUE DESIGNATION : JR TECHNICAL SERVICE EXECUTIVE

PLACE VISITED AMOUNT
Sln. Claim Date Name of the Place (s) visited Purpose of Visit Mode of Travel KM. Conveyance Fixed Monthly Total Claim
From To
Amount (INR) Expense (INR) Amount (INR)

1 1/Sep/23 Achalpur Chandur Bazar Chandur Bazar Kharwadi Ridhpur Site Visit Build Advisor 105 175 175.00
2 2/Sep/23 Achalpur Achalpur Dariyabad Hanwatkheda Melghat Dhamangaon gadi Site Visit Bike 112 392 175 567.00
3 4/Sep/23 Achalpur Achalpur Achalpur Paratwada karpi mughlai Site Visit Bike 106.8 373.8 175 548.00
4 5/Sep/23 Achalpur Chandur Bazar Chandur bazar Ridhpur Site Visit Bike 109.3 382.55 175 557.55
5 6/Sep/23 Achalpur Chandur Bazar Chandur Bazar Sirajgao kasba Badnapur melghat Site Visit Bike 123 430.5 175 605.50
6 7/Sep/23 Achalpur Chandur Bazar Chandur Bazar paratwada Sirajgao kasba Site Visit Build Advisor 160 175 175.00
7 8/Sep/23 Achalpur chandur bazar and Paratwada Chandur Bazar Paratwada Site Visit Build Advisor 103 175 175.00
8 9/Sep/23 Achalpur Achalpur Asadpur Achalpur Site Visit Build Advisor 110 175 175.00
9 11/Sep/23 Achalpur Chandur Bazar Chandur Bazar Ghatladki Sirajgao kasba Site Visit Bike 106 371 175 546.00
10 12/Sep/23 Achalpur Morshi Morshi Storming Activity Bike 155.8 545.3 175 720.00
11 13/Sep/23 Achalpur Achalpur Borala Satti Shanur Melghat Area . Site Visit Bike 122 427 175 602.00
12 14/Sep/23 Achalpur Chandur Bazar Chandur Bazar Nearby Area Site Visit Bike 103.7 362.95 175 537.95
14 15/Sep/23 Achalpur Achalpur Achalpur Paratwada Site Visit Bike 55 192.5 100 292.50
15 16/Sep/23 Achalpur Achalpur Achalpur Chandur bazar Site Visit Bike 85 297.5 100 397.50
16 18/Sep/23 Achalpur Achalpur Achalpur Boregao peth Site Visit Bike 86.8 303.8 100 403.80
17 19/Sep/23 Achalpur Holyday Holyday Holyday Holyday
18 20/Sep/23 Achalpur Achalpur Achalpur Boregao peth Site Visit Build Advisor 132 175 175.00
19 21/Sep/23 Achalpur Chandur Bazar Chandur Bazar Gahtladki Site Visit Build Advisor 120 175 175.00
20 22/Sep/23 Achalpur chandur Bazar Chandur Bazar Kawitha talegaon mohna Site Visit Build Advisor 135 175 175.00
21 23/Sep/23 Achalpur Achalpur Paratwada kothara Site Visit Build Advisor 125 175 175.00
22 25/Sep/23 Achalpur Achalpur Achalpur Wadegao Fattepur Paratwada Site Visit Bike 86.2 301.7 100 401.70
23 26/Sep/23 Achalpur Chandur Bazar Chandur bazar Kharwadi Site Visit Bike 107.3 375.55 175 550.55
24 27/Sep/23 Achalpur chandur Bazar chandur bazar vichori Site Visit Bike 101.1 353.85 175 528.85
25 28/Sep/23 Achalpur Achalpur Achalpur Paratwada Dhotarkheda Dhamangao Site Visit Bike 98.2 343.7 100 443.70
26 29/Sep/23 Achalpur Achalpur Achalpur Dhotarkheda Site Visit Bike 84 294 100 394.00
27 30/Sep/23 Achalpur chandur bazar chandur bazar sirajgao kasba Site Visit Bike 100.8 352.8 175 527.80

6,100.50 3,925.00 10,024.40

Signature of Associate :

Signature of Client (Dalmia Cement Bharat Limited) :

Signature of Branch Head (Genius) :

 OUT-STATION LOCAL CONVEYANCE STATEMENT
Claim Period : From: ______ To: ______
NAME : DESIGNATION :
City/ Town visited (Tour/ Travel, if any, else mention NA):
PLACE VISITED
Out-Station
Local
Sln. Claim Date Name of the Place (s) visited Purpose of Visit Mode of Travel KM.
From To Conveyance
Amount (INR)

0.00
Signature of Associate :

Signature of Client (Dalmia Cement Bharat Limited) :

Signature of Branch Head (Genius) :