Free form template · Word

Mobile Reimbursement Form

A mobile reimbursement form is used to claim back personal mobile phone bills or recharges used for official work, up to the monthly limit set for the employee's grade. It lists each bill or recharge, applies the cap and carries the manager's approval for payroll credit.

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[Company Logo][Company Name]

MOBILE REIMBURSEMENT CLAIM

Company:: [Company Name]
Claim Month / Quarter:: [Period]
Claim No.:: [Reference Number]
Date:: [Date]

Employee Details

Employee Name
Employee ID
Grade
Department
Registered Mobile Number
Monthly Limit: ₹[Amount]

Bill / Recharge Details

Mobile No.	Operator	Postpaid / Prepaid	Bill or Recharge Date	Period Covered	Amount (₹)
[Mobile No.]	[Operator]	[Postpaid]	[DD/MM/YYYY]	[Month]	[Amount]
[Mobile No.]	[Operator]	[Prepaid]	[DD/MM/YYYY]	[28 days]	[Amount]
[Mobile No.]	[Operator]	[Prepaid]	[DD/MM/YYYY]	[28 days]	[Amount]
				Total Billed	[Amount]

Claim Calculation

Total Billed (₹)	Eligible Limit for Period (₹)	Admissible Amount (₹)
[Amount]	[Amount]	[Amount]

Declaration

I certify that the mobile connection listed is used by me for official purposes, the bills and receipts attached are genuine, and I have not claimed these amounts from any other source.

Employee
[Employee Name]
Date: [Date]

Approved by
[Reporting Manager]
Date: [Date]

Payroll
[HR Name]
Paid in: [Month]

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What this template includes

Grade-wise monthly limit
Bill or recharge table with number, operator and period
Prepaid recharge proof rules
Official use declaration
Amount admissible after cap
Manager approval and payroll month

When to use it

Sales, field and client-facing staff who use personal phones for work
Employees whose CTC includes a telephone reimbursement component
Remote employees claiming mobile data used for work
Monthly or quarterly bill submission cycles

How to customise this template

1Add your grade-wise limits
2Decide whether bills must be in the employee's name
3Choose monthly or quarterly claims
4Mention whether international roaming on business trips is covered separately

HR tips

Accept recharge receipts with mobile number and date as proof
Do not reimburse handset EMIs through this form
Pay only up to the limit, even if the bill is higher
Keep the form separate from internet and landline claims

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Frequently asked questions

Can I claim mobile bills not in my name?+

Some companies allow bills in a family member's name if the number is registered with HR. Check your policy.

Are prepaid recharges reimbursable?+

Usually yes, with a recharge receipt showing the number, date and amount.

What if my bill exceeds the limit?+

Only the amount up to your grade limit is reimbursed; the balance is borne by you.

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[Company Logo][Company Name]
INTERNET REIMBURSEMENT CLAIM (WORK FROM HOME)
Company:
[Company Name]
Claim Period:
[Month]
Claim No.:
[Reference Number]
Date:
[Date]
Employee Details
Employee Name
Employee ID
Department
Work Arrangement: Remote / Hybrid
Registered Home Address
Connection Details
Internet Service Provider
Plan Speed (Mbps)
Billing Cycle: Monthly / Quarterly / Annual
Account Holder Name
Relationship (if not self)
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[Company Logo][Company Name]
FUEL / CONVEYANCE REIMBURSEMENT CLAIM
Company:
[Company Name]
Claim Month:
[Month / Year]
Claim No.:
[Reference Number]
Date:
[Date]
Employee and Vehicle
Employee Name
Employee ID
Department
Territory / Beat
Vehicle Type: Two-wheeler / Car
Registration Number
Owned by: Self / Family
Driving Licence Valid till
Vehicle Insurance Valid till
Method
- Per-km method: two-wheeler ₹[Amount]/km, car ₹[Amount]/km
- Fuel bill method: actual bills up to ₹[Amount] per month
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[Company Logo][Company Name]
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)
Expense Details
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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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Annual Limit (₹)	Claimed So Far (₹)	This Claim (₹)	Balance After Claim (₹)
[Amount]	[Amount]	[Amount]	[Amount]

Internet Service Provider
Plan Speed (Mbps)
Billing Cycle: Monthly / Quarterly / Annual
Account Holder Name
Relationship (if not self)

Annual Entitlement (₹)	Claimed till Last Quarter (₹)	This Claim (₹)	Balance (₹)
[Amount]	[Amount]	[Amount]	[Amount]

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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[Company Logo][Company Name]

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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Employee Name
Employee ID
Department
Territory / Beat
Vehicle Type: Two-wheeler / Car
Registration Number
Owned by: Self / Family
Driving Licence Valid till
Vehicle Insurance Valid till

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

Mobile Reimbursement Form

Preview of the form

Employee Details

Bill / Recharge Details

Claim Calculation

Declaration

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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