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Free form template · Word

Fuel Card Issue Form

A fuel card issue form records the handover of a company fleet or fuel card to an employee or driver, linking it to a specific vehicle with a monthly rupee limit and permitted uses. Admin uses it to control fuel spending, assign responsibility for PIN security and set how statements will be reconciled.

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  • Made for India
  • 21 fill-in fields highlighted
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Preview of the form

[Highlighted] = fill in
[Company Logo][Company Name]

FUEL CARD ISSUE FORM

Ref. No.:
[Reference Number]
Date:
[Date]
Card Provider:
[Oil Company / Bank Name]
Customer / Account ID:
[Account Number]

1. Card Holder

Name[Employee Name]
Employee ID / Driver ID[Employee ID]
Designation[Designation]
Department / Territory[Department]
Reporting Manager[Reporting Manager]
Mobile (for transaction alerts)[Mobile Number]

2. Card and Vehicle Details

Card No. (last 4 digits)Card Valid TillLinked Vehicle Reg. No.Vehicle TypeFuel Type
XXXX [Last 4 Digits][MM/YYYY][Registration Number]Car / Two-wheeler / CommercialPetrol / Diesel / CNG

3. Limits and Permitted Use

ControlApproved
Monthly limit₹[Amount]
Per-transaction limit₹[Amount]
Daily transaction count[Number]
Permitted productsFuel only / Fuel and lubricants
Cash withdrawalNot permitted

4. Card Holder Undertaking

  1. I will use the card only to fuel the linked vehicle [Registration Number] for official travel.
  2. I will keep the card and PIN secure, and will never share the PIN or let anyone else use the card.
  3. I will record the odometer reading in the trip log at every fill.
  4. I will keep fuel receipts or e-receipts and submit the monthly trip log by [Day] of the following month.
  5. I will report loss of the card immediately to Admin so that it can be blocked.
  6. Any use for a non-linked vehicle or non-official purpose may be recovered from me as per company policy.
  7. I will return the card on exit, change of vehicle, or when asked.

5. Monthly Reconciliation (Admin use)

MonthCard Spend (₹)Km DrivenAverage (km / litre)RemarksChecked By
[Month][Amount][Kilometres][Average][Remarks][Admin Name]
[Month][Amount][Kilometres][Average][Remarks][Admin Name]
[Month][Amount][Kilometres][Average][Remarks][Admin Name]

I acknowledge receipt of the fuel card described above in a sealed envelope with the PIN, and agree to the limits and undertaking stated in this form.

Card Holder
[Employee Name]
Date: [Date]
Issued by
[Admin Name]
Administration
Date: [Date]
Approved by
[Reporting Manager]
Date: [Date]

What this template includes

  • Card number (masked) and issuing oil company or bank
  • Linked vehicle registration number
  • Monthly and per-transaction limits in rupees
  • Permitted products, such as fuel only
  • PIN confidentiality and loss reporting
  • Monthly statement reconciliation with trip logs

When to use it

  • A company vehicle is allotted and fuel is paid by card
  • Field staff with two-wheelers are given fuel cards instead of reimbursement
  • A driver for a pool vehicle receives a card
  • A card is replaced after loss or expiry

How to customise this template

  1. 1Add your fuel card provider and customer ID
  2. 2Set limits by vehicle type or role
  3. 3Decide whether lubricants, washing or tolls are permitted
  4. 4Explain how excess or non-official use will be handled
  5. 5Attach the vehicle issue form reference

HR tips

  • Link each card to one vehicle so statements are easy to check
  • Show only the last four digits of the card number on forms
  • Review statements monthly against odometer readings
  • Block the card immediately when lost or on exit

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Frequently asked questions

Why link a fuel card to a vehicle number?+

It ensures the card is used only for that vehicle and makes it easier to compare fuel spend with kilometres driven.

What if an employee exceeds the fuel card limit?+

Most cards block transactions beyond the set limit. If a higher limit is needed, the manager can approve a change in writing.

Can a fuel card be used for personal vehicles?+

Usually not. A company fuel card is linked to an official vehicle and should be used only for it, unless the policy says otherwise.