PHARMARACK Expense Reimbursement Form

(Please read REIMBURSEMENT PAYMENT POLICY & PROCEDURES before filling the form)

Employee Name: Nikhil Goyal Reporting Manager - Level 1 Mr. Hitesh Mitawa
Employee Designation Sri Ganganagar Reporting Manager - Level 2 (only for exceptions) Mr.Surya Prakash
Employee Grade For the Month 1-Jul-24
Employee Code 15827 Department: Sales
Base Location Sri Ganganagar

Remark /Bills Approved Amt by

Sr. DATE From Place To Place Joint Work with No of calls Visit Location KM Travel Fare HQ Allowance EX HQ Outstation Food Vehicle Phone /Data MISC Exp Other Specify Attchd Amt in Rs Reporting
No done Allowance Allowance Allowance (Yes/No) Manager
1 1st Sri Ganganagar Sri Ganganagar 15 Sri Ganganagar 0 250 0 800 750 250 2050
2 2nd HANUMANGARH HANUMANGARH 12 HANUMANGARH 120 480 0 400 880
3 3rd Sri Ganganagar Sri Ganganagar 13 Sri Ganganagar 0 0 250 0 250
4 4th Sri Ganganagar Sri Ganganagar 15 Sri Ganganagar 0 0 250 0 250
5 5th Sri Ganganagar Sri Ganganagar 15 Sri Ganganagar 0 0 250 0 250
6 6th Sri Ganganagar Sri Ganganagar 19 Sri Ganganagar 00 250 0 250
7 7th SUNDAY SUNDAY 0 SUNDAY 0 0 0 0 0
8 8th Sri Ganganagar Sri Ganganagar 20 Sri Ganganagar 0 0 250 0 250
9 9th Sri Ganganagar Sri Ganganagar 20 Sri Ganganagar 0 0 250 0 250
10 10th LEAVE LEAVE 0 LEAVE 00 0 0 0
11 11th LEAVE LEAVE 0 LEAVE 0 0 0 0
12 12th LEAVE LEAVE 0 LEAVE 00 0 0 0
13 13th LEAVE LEAVE 0 LEAVE 00 0 0 0
14 14th SUNDAY SUNDAY 0 SUNDAY 00 0 0 0
15 15th Sri Ganganagar Sri Ganganagar 17 Sri Ganganagar 00 250 0 250
16 16th Sri Ganganagar Sri Ganganagar 23 Sri Ganganagar 00 250 0 250
17 17th Sri Ganganagar Sri Ganganagar 21 Sri Ganganagar 00 250 0 250
18 18th Sri Ganganagar Sri Ganganagar 20 Sri Ganganagar 00 250 0 250
19 19th HANUMANGARH HANUMANGARH 16 HANUMANGARH 120 480 0 400 880
20 20th Sri Ganganagar Sri Ganganagar 24 Sri Ganganagar 00 250 0 250
21 21st SUNDAY SUNDAY 0 SUNDAY 00 0 0 0
22 22nd Sri Ganganagar Sri Ganganagar 23 Sri Ganganagar 00 250 0 250
23 23rd Sri Ganganagar Sri Ganganagar 24 Sri Ganganagar 00 250 0 250
24 24th Sri Ganganagar Sri Ganganagar 20 Sri Ganganagar 00 250 0 250
25 25th Sri Ganganagar Sri Ganganagar 22 Sri Ganganagar 00 250 0 250
26 26th HANUMANGARH HANUMANGARH 15 HANUMANGARH 120 480 0 400 880
27 27th Sri Ganganagar Sri Ganganagar 24 Sri Ganganagar 00 250 0 250
28 28th SUNDAY SUNDAY 0 SUNDAY 00 0 0 0
29 29th Sri Ganganagar Sri Ganganagar 21 Sri Ganganagar 00 250 0 250
30 30th Sri Ganganagar Sri Ganganagar 22 Sri Ganganagar 00 250 0 250
31 31st Sri Ganganagar Sri Ganganagar 18 Sri Ganganagar 0 250 25000.00%
TOTAL GROSS AMOUNT 360 1440 4750 1200 0 0 800 750 250 0 0 9440 -
Less: Advances
Less: Deductions
Total Net to be Paid 9,440 -

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Employee Reporting Authority

Date Date