Airfare Reimbursement Form

Select Event *

Claim Submitting for: *

Air Fare
Freight

Company Name *

IEC No. *

Email *

Contact No. *

F.O.B Value of Exports in 2023-24 *

Name of the Person who Traveled *

Designation *

Passport No. *

Place of Issue *

Date of Issue *

Date of Expiry *

Travel Itnonary

Departure Flight Details *

Direct Flight
Connecting Flight

Origin Place (Departure) *

Date of departure from Origin *

Final Destination (Place) *

Final Destination Date *

Return Flight Details *

Direct Flight
Connecting Flight

Origin Place (Departure) (Return) *

Date of departure from Origin (Return) *

Final Destination (Place) (Return) *

Final Destination Date (Return) *

Expenditure Incurred (Air Fare) *

Amount Claimed (Air Fare): *

Bank Details

Company Name in Bank *

Bank Name *

Current Account No. *

IFSC Code *

Upload Documents (1 Single pdf contain all Documents) *

Less than 8 mb

DECLARATION *

I Accept

I/We hereby solemnly undertake and declare that the particulars stated above are true and correct to the best of my/our knowledge and belief.
No other application for travel cost has been made or will be made in future against this bill.
Any information, if found to be incorrect, wrong or misleading, will render/us liable to rejection of our claim without prejudice to any other action that may be taken against us in this behalf.
If as a result of scrutiny any excess payment is found to have been made to me/us, the same may be adjusted against any of the subsequent claims to be made by me/our firm or in the event no claim is preferred the amount overpaid will be refunded by me/us to the extent of the excess amount paid.

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