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Jharsuguda, Orissa
CLAIM FOR LEAVE TRAVEL CONCESSION FOR THE YEAR 2011
NAME
EMP NO : DOJ :
PLACE VISITED
I HEREBY CERTIRY THAT I WAS ON LEAVE FROM TO VISIT JAMNAGAR, AHEMADABAD & MUMBAI MAY BE REIMBURSED RS. 57,450 (RUPEES
29/08/2011
TO
08/09/2011
TO
CHECKED BY
GENERAL MANAGER(F&A)
DECLARATION UNDER RULE 2-B OF THE INCOME TAX RULES ,1962 1. Name of the Employee Huzefa Hussain
2.
Name of the family members whose travelling Expenses are claimed indicating the relationship With the employee (if parent, brother or sisters, it Should be declared whether they are solely or mainly Dependent on the employee) Whether this is first or second journey during the Block period and whether it is carried over from the Last back. i) ii) Place to which journey undertaken (Destination) Period of leave from 29/08/11
3.
4.
5.
Date of departure from Head Quarter Date of arrival at destination Date of commencement of return journey Date of return to Head Quarter
6. 7. 8.
Route taken (if it is not shortest route) Distance of actual route of the shortest route Whichever is lesser. Actual mode of travel by Air/Rail/Bus/Car/ Ship if more than one mode is used state Separately the mode and distance. Amount of reimbursement eligible and other Companies rule. Actual expenses incurred by the employee On travel alone during the above journey to And fro. Amount eligible for exemption with reference To the permitted mode of travel by the shortest Route indicating such distance and the rate Adapted limited to actual expenses. 4200 km Car
9. 10.
57,450/58,800/-
11.
57,450/-
It is certified that the information furnished above are true and correct that the amount claimed by way of exemption under Section 10(V) has been actually spent as expenses on travel fares Signature of the employee