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One97 Communications Limited

Mobile Reimbursement Form (Annexure I)

Name: Raj Kumar Tiwari

Deartment: Mobile Internet

!rade: MG1

"mlo#ee Code : 13260

Mobile Number 9560010354

Period o bill 23!"ul!2015 to 22!#u$!2015

%ill Number 954463264

%ill &ate 24'0('2015

#mount o %ill )R*+, 595

-e**. Per*onal /*a$eall* ter*

GPR 595

Amount o$ Claimed (Rs%) &9&

Name o aroin$ ! Reortin$ Mana$er Kuntal Kumar a*an

Name o aroin$ ! 7ead o &eartment Gamandee in$

Note - The reimbursement can be claimed only on the basis of actuals & submissions of the original bills/ supp

&ate. 13'10'2015

i$nature o 8laimant

i$nature o Reortin$ Mana$er

i$nature o 7ead o &eartment

All fields are mandatory

Reortin' mana'eread o$ Deartment aro*es to start t+e a#ment rocess% Finance ,ill re*ie, andne'otiate to aro*e a$ter seein' t+e olic# *ariance%

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