Free form template · Word

Expense Settlement Form

An expense settlement form closes out an employee advance or imprest float, other than travel, by comparing the amount given with actual bills. It shows whether the employee owes a refund or is due a shortfall payment, and records how and when finance closed the advance.

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[Company Logo][Company Name]

EXPENSE / ADVANCE SETTLEMENT STATEMENT

Company:: [Company Name]
Settlement No.:: [Reference Number]
Date:: [Date]

Employee and Advance

Employee Name
Employee ID
Department
Advance No.
Advance Date
Advance Purpose: Event / Project / Site Imprest / Other
Advance Amount (₹)

Actual Expenses

Expense Head	No. of Bills	Amount (₹)
[Venue / Material]	[Number]	[Amount]
[Food and Refreshments]	[Number]	[Amount]
[Local Transport]	[Number]	[Amount]
[Miscellaneous]	[Number]	[Amount]
Total Actuals		[Amount]

Settlement Calculation

Particulars	Amount (₹)
Advance Received (A)	[Amount]
Admissible Actual Expenses (B)	[Amount]
Refund Due from Employee (A - B, if positive)	[Amount]
Shortfall Payable to Employee (B - A, if positive)	[Amount]

Mode of Settlement

Refund by bank transfer, UTR No. [Reference Number]
Recovery from salary of [Month], as per my consent below
Shortfall to be paid through payroll / bank transfer

Declaration and Consent

I certify that the bills attached are genuine and relate to the purpose for which the advance was given. I authorise [Company Name] to recover any refund due from my salary, or from my full and final settlement if I leave before it is recovered.

Employee
[Employee Name]
Date: [Date]

Verified by
[Reporting Manager]
Date: [Date]

Finance
[Name]
Advance Closed on: [Date]

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What this template includes

Advance reference, date and amount
Bills summary by expense head
Advance versus actual comparison
Refund or shortfall calculation
Refund mode or payroll recovery with consent
Finance closure stamp

When to use it

Closing an event or project advance after the event
Monthly settlement of a site imprest or petty cash float
Clearing all open advances before an employee's full and final settlement
Year-end clean-up of outstanding employee advances

How to customise this template

1Link to your advance numbering system
2Add imprest replenishment fields for site floats
3Set the deadline for settlement
4Include an F&F flag for exiting employees

HR tips

Settle each advance separately to keep ledgers clean
Recover excess advances promptly with documented consent
Flag ageing advances to managers monthly
Do not issue a new advance while an old one is open, unless policy allows

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Frequently asked questions

What is an expense settlement?+

It is the process of accounting for an advance by submitting bills, so the company can close the advance and either refund the employee or recover the balance.

How is an unspent advance returned?+

Either by bank transfer to the company or, with the employee's consent, by deduction from salary.

Is this different from a travel expense claim?+

A travel claim covers a specific tour. This form is for any other advance or imprest, though it can also summarise multiple claims.

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MEDICAL EXPENSE CLAIM FORM
Company:
[Company Name]
Claim No.:
[Reference Number]
Date:
[Date]
Claimant Details
Employee Name
Employee ID
Department
Work Location
ESI Covered: Yes / No
Reason for Claim (tick one)
- Minor injury at workplace, Incident Report No. [Reference Number]
- Company-mandated medical test (pre-employment / periodic / food handler)
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- Other approved reason: [Details]
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EXPENSE REIMBURSEMENT CLAIM
Company:
[Company Name]
Claim No.:
[Reference Number]
Claim Period:
[Month]
Date:
[Date]
Claimant
Employee Name
Employee ID
Department
Cost Centre / Project Code
Reporting Manager
Expense Categories
- C1 Client entertainment
- C2 Courier and postage
- C3 Stationery and printing
- C4 Software and subscriptions (pre-approved)
- C5 Team supplies and refreshments
- C6 Other (specify)
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[Company Logo][Company Name]
EMPLOYEE BENEFITS ENROLLMENT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date of Submission:
[Date]
Enrollment Deadline:
[DD/MM/YYYY]
Please complete all sections within the enrollment window and return this form to [HR Name], Human Resources. Benefits will be activated only after HR verification.
Section A: Employee Details
Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)
Section B: Statutory Benefits
UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No
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Expense Type: Team Event / Training / Client Gift / Purchase / Other
Description
Business Justification
Date Required By
Number of Beneficiaries / Attendees

Employee Name (as per PAN)
Employee ID
Designation
Department
Date of Joining
Work Location
Date of Birth
Gender
Mobile Number
Personal Email
PAN
Aadhaar (last 4 digits only)

UAN (if already allotted)
Previous PF Account / Member ID
ESI IP Number (if applicable, for gross wages up to ₹21,000/month)
Opting for higher PF contribution: Yes / No

[Company Logo][Company Name]

FLEXIBLE BENEFITS SELECTION FORM

Company:: [Company Name]
Financial Year:: [FY 20XX-XX]
Submission Date:: [Date]
Payroll Cut-off:: [DD/MM/YYYY]

Part 1: Employee Information

Employee Name
Employee ID
Designation
Department
Annual CTC: ₹[CTC]
Annual Flexi Basket: ₹[Amount]
Tax Regime Opted: Old / New

Part 2: Allocation of Flexi Basket

Component	Company Limit per Month (₹)	My Monthly Allocation (₹)	Annual Allocation (₹)	Bills Required
Meal Card / Food Coupons	[Amount]	[Amount]	[Amount]	No (card based)
Fuel and Vehicle Maintenance	[Amount]	[Amount]	[Amount]	Yes
Telephone and Internet	[Amount]	[Amount]	[Amount]	Yes
Leave Travel Allowance	[Amount]	[Amount]	[Amount]	Yes, travel proof
Books and Periodicals	[Amount]	[Amount]	[Amount]	Yes
Employer NPS Contribution	[Amount]	[Amount]	[Amount]	No
Total (must equal flexi basket)	-	[Amount]	[Amount]	-

Part 3: Terms

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GROUP INSURANCE NOMINATION FORM

Company:: [Company Name]
Policy:: Group Term Life / Group Personal Accident
Insurer:: [Insurer Name]
Policy No.:: [Policy Number]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Designation
Department
Date of Birth
Date of Joining
Marital Status

Nominee Details

Nominee Name	Relationship	Date of Birth	Address and Mobile	Share (%)
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
[Nominee Name]	[Relationship]	[DD/MM/YYYY]	[Address, Mobile]	[%]
Total				100%

Appointee (only if a nominee is a minor)

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MEDICLAIM DECLARATION
Company:
[Company Name]
Policy Year:
[DD/MM/YYYY] to [DD/MM/YYYY]
Date:
[Date]
A. Employee Particulars
Employee Name
Employee ID
Department
Designation
Date of Birth
Contact Number
B. Choice of Cover (tick one)
- I opt IN to the group mediclaim for myself and the dependants listed in Part C.
- I opt IN for myself only.
- I opt OUT of the group mediclaim. I am covered under policy no. [Policy Number] with [Insurer Name]. I understand I cannot claim under the company policy and may rejoin only at renewal, if permitted.
C. Dependants Declared for this Policy Year
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HEALTH INSURANCE CLAIM SUBMISSION FORM (INTERNAL)
Company:
[Company Name]
Insurer / TPA:
[Insurer Name] / [TPA Name]
Policy No.:
[Policy Number]
Internal Claim Ref.:
[Reference Number]
Date of Submission:
[Date]
Important: This form helps HR process your claim. The insurer's or TPA's official claim form must also be completed, signed and attached where required.
1. Employee Details
Employee Name
Employee ID
Department
Mobile Number
Email ID
2. Patient Details
Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)
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Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)

Employee Name
Employee ID
Department
Cost Centre / Project Code
Reporting Manager

Expense Settlement Form

Preview of the form

Employee and Advance

Actual Expenses

Settlement Calculation

Mode of Settlement

Declaration and Consent

What this template includes

When to use it

How to customise this template

HR tips

Hire top talent from BetterJobs

Frequently asked questions

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