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Item of expense
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Amount (Rs)
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Statement of purpose:
Invoice /Receipt details
( if available):
I
hereby declare that the above expense is incurred exclusively for
official purpose and hence submitted for reimbursement.
Name of the applicant
Designation
Signature
Date
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Office use
Certified
that the attached invoices/receipts are eligible for reimbursement and these
expenses have not been claimed elsewhere.
Approved
by
Name
Signature
