VEHICLE LOG DETAILS
NAME: RESIDENTIAL
EMP NO: ADDRESS:
MONTH OF EXPENDITURE:
DATE OF SUBMISSION: VEHICLE NO:
S No Date of Travel (weekends, Origin Start Km Destination End KM Total Number of Purpose of Travel Mileage (KMs Fuel (INR) Fuel Bill Date of Bill
public holidays, leave etc. (HOME / (HOME / KMs per litre of Reference No
when employee does not OFFICE) OFFICE) fuel) (Original bill to
commute to office/does not be appended to
travel for official purposes this form)
should be excluded)
0 Travel from home to office
0 Travel from home to office
0 Travel from home to office
0 Travel for official purposes/meetings
0 Travel from home to office
0 Travel for official purposes/meetings
0 Travel from home to office
0 Travel from home to office
0 Travel for official purposes/meetings
0 Travel from home to office
0 Travel from home to office
0 Travel from home to office
Total 0
VERIFICATION: I have incurred the above mentioned fuel expenditure towards my commute to and fro from home to office and/or for travel for official purposes/meetings. I hereby certify that the information given above
is complete and correct and I undertake to reimburse my employer for any tax, penalty or other charges levied by the Income tax authorities at any later date arising on account of my submission of any false / incorrect
claim in respect of the above stated expenditure.
Signature of Employee
DECLARATION BY EMPLOYER: Based on the information provided above, we hereby certify that the above expenditure was incurred by the employee wholly and exclusively for the performance of official duties.
Signature of Employer:
DETAILS OF DRIVER CHARGES
NAME : DRIVER NAME:
EMP NO : VEHICLE NO:
MONTH OF EXPENDITURE: DATE OF SUBMISSION:
BILL NO <if applicable> DATE OF PAYMENT OF Amount of Driver salary towards
SALARY (Proof of payment ie commute to and fro from home to office
salary slip, bank entry etc. to be and/or for travel for official
submitted) purposes/meetings (INR)
Total 0
VERIFICATION: I have expended the above driver's salary towards commute to and fro from home to office
and/or for travel for official purposes/meetings. I hereby certify that the information given above is
complete and correct and I undertake to reimburse my employer for any tax, penalty or other charges levied
by the Income tax authorities at any later date arising on account of my submission of any false / incorrect
claim in respect of the above stated expenditure.
Signature of Employee:
DECLARATION BY EMPLOYER: Based on the information provided above, we hereby certify that the above
expenditure was incurred by the employee wholly and exclusively for the performance of official duties.
Signature of Employer:
