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Declaration

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abhijit bhoj
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41 views1 page

Declaration

Uploaded by

abhijit bhoj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ANNEXURE 1

DECLARATION AND EXPENSE CLAIM FORM FOR REIMBURSEMENT OF FUEL, MAINTENANCE AND
DRIVER’S SALARY FOR SELF-OWNED VEHICLE
Name: Abhijit Bhoj

WWID: KX796

Claim Number: 104743


(Req. no. generated post submission of claim)
This is to certify that, below mentioned Vehicle is owned & used by me. I have incurred the below expenses and neither my
family members nor I have claimed it earlier.
• Vehicle Number: MH12QT8930
• Vehicle make & Model: Maruti Suzuki Baleno CVT Zeta
• Vehicle ownership as per RC: Abhijit Bhoj
• Vehicle engine capacity (Select only one vehicle type as applicable from below): Four Wheeler Up to 1600 CC
Upto 1600 CC / More than 1600 CC / Other Automotive conveyance (Two – wheeler) -
• Driver services (applicable only in case of four wheeler): Yes / No (if yes, provide below details) No
• Name of driver: N/A
• Driver’s license number & validity: N/A
• Mode of salary payment to the driver: N/A

Date of
Expense type Bill No. Paid to (Vendor) Amount
payment

Fuel 261946 23/12/12024 Janki Petrolieum Wai 1000

TOTAL 1000
I understand and agree that only the amount spent in line with this policy shall be considered as reimbursement &
appropriate tax benefit shall be provided. Balance amount (if any) is taxable under the Income Tax Act, 1961
• Amount reimbursed will be according to grade/policies.
• Certified that the necessary bills/expenses would be submitted by me to the concerned authorities within the stipulated
time to get the reimbursement claim.
• Certified, I will be solely responsible to satisfy tax authorities about the correctness of the amount claimed as
reimbursement.
I hereby declare that the information provided by me is true and correct to the best of my knowledge.

Mandatory documents required for claim approval:


1. Signed declaration/Annexure-1 form.
2. Fuel bill mentioning minimum bill number, date & amount (other details as provided by vendor). Only payment
transaction receipt will not be allowed.
3. Maintenance & Insurance bill with payment receipt/transaction details (if paid in cash and paid amount is above rupees
five thousand, payment receipt must be affixed with revenue stamp and cross signed).
4. For driver salary reimbursement - Driver salary payment receipt with payment details for online payment. (If paid online,
online payment transaction details. If paid in cash and paid amount is above five thousand, receipt must be affixed with
revenue stamp and cross signed by the driver).
I hereby ensure that hard copy of the declaration form with the supporting bills will be submitted to CBS team in
given stipulated timelines to continue the exemption benefit against the claim.
Digitally signed by kx796 Bhoj,
Signature: kx796 Bhoj, Abhijit Abhijit
Date: 2024.05.07 21:34:57 +05'30'

Contact No: 7720072748


Date: 24/12/2024

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