Doc No.
HRD/FRM-15
LEAVE FARE REIMBURSEMENT APPLICATION Rev.: 01, Date: May 23, 2011
Page 1 of 1
Employee Name Employee ID Date of Joining
BA / BSD Grade Entitled Amount
Section A: Details of Costs Incurred on Travelling
Relationship Place(s) Visited
Sr. No. Name Mode of Travelling Amount
with Employee From To
Total Cost
Claimant : Verified by:
Designation: Head of Department:
(signature/date)
Section B: For the Use of Administration Department Only
Earned Leave Status For the Period: to
No of Earned Leaves Availed for the mentioned Period:
Comments (if any) :
Attendance Coordinator In-charge Administration
(signature/date) (signature/date)
Section C: For the Use of Finance Department Only
Payment of LFA Due for the Period to
LFA Due Date LFA Entitled Amount
Approved by:
Recorded in LFA Payment Log Financial Controller
(signature/date) (signature/date)
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