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Vehicle Fuel and Maintenance Reimbursement Form

This is a vehicle fuel and maintenance reimbursement form for an employee. It includes fields for the employee's name, code, designation, department, vehicle number, and month. It has sections to enter details of fuel costs including quantity, rate and amount. It also has a section for maintenance costs with amount and remarks. At the bottom it specifies the total amount and includes fields for office use like voucher number, date, reimbursement amount, eligible amount and sanctioned amount. The employee certifies the expenses and signatures are required from the employee, checker and approver.

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anon_933416755
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68 views2 pages

Vehicle Fuel and Maintenance Reimbursement Form

This is a vehicle fuel and maintenance reimbursement form for an employee. It includes fields for the employee's name, code, designation, department, vehicle number, and month. It has sections to enter details of fuel costs including quantity, rate and amount. It also has a section for maintenance costs with amount and remarks. At the bottom it specifies the total amount and includes fields for office use like voucher number, date, reimbursement amount, eligible amount and sanctioned amount. The employee certifies the expenses and signatures are required from the employee, checker and approver.

Uploaded by

anon_933416755
Copyright
© All Rights Reserved
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

COMPANY NAME

ADDRESS
VEHICLE FUEL/MAINTENANCE REIMBURSEMENT FORM
Name : Location :
Code : Region :
Designation : Vehicle No. :
Department : Month :

A. FUEL Eligibility (in Ltrs) : Petrol / Diesel


[Link]. Particulars Qty (In Ltrs) Rate Amount Ramarks

Total

B. MAINTENANCE Eligibility (in Rs.) :


[Link]. Particulars Amount Ramarks

Total
Rupees in words (A+B):
Total (A+B) : Rs.

FOR OFFICE USE ONLY


Voucher No. Date Reimbursement Amount
Cheque No. Date Eligible Amount
Bank Name Sanctioned Amount
I Certify that I have incurred an expenses amount of vehicle Fuel /
Maintenance are correct.

Signature of the Employee with Date Checked By Approved By


Signature of the Employee with Date Checked By Approved By

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