Free form template · Word

Travel Expense Claim

A travel expense claim form is the post-trip statement an employee submits after an official tour, listing fares, hotel, daily allowance and local travel day by day. It adjusts any travel advance taken and shows the net amount payable to the employee or refundable to the company.

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[Company Logo][Company Name]

TRAVEL EXPENSE CLAIM

Company:: [Company Name]
Claim No.:: [Reference Number]
Travel Approval / Advance No.:: [Reference Number]
Date:: [Date]

Employee and Trip

Employee Name
Employee ID
Grade
Department
Cost Centre
Purpose of Trip
Places Visited
Departure	[DD/MM/YYYY] [HH:MM]
Return	[DD/MM/YYYY] [HH:MM]

Day-wise Expense Sheet

Date	City	Fare (₹)	Hotel (₹)	DA (₹)	Local Travel (₹)	Other (₹)	Bill / GST Invoice No.
[DD/MM/YYYY]	[City]	[Amount]	[Amount]	[Amount]	[Amount]	[Amount]	[Invoice No.]
[DD/MM/YYYY]	[City]	[Amount]	[Amount]	[Amount]	[Amount]	[Amount]	[Invoice No.]
[DD/MM/YYYY]	[City]	[Amount]	[Amount]	[Amount]	[Amount]	[Amount]	[Invoice No.]
Total		[Amount]	[Amount]	[Amount]	[Amount]	[Amount]

Settlement

Item	Amount (₹)
Total Expenses Claimed	[Amount]
Less: Amount above entitlement (not approved)	[Amount]
Admissible Expenses	[Amount]
Less: Travel Advance Taken	[Amount]
Net Payable to Employee / (Refundable to Company)	[Amount]

Declaration

I certify that the expenses above were incurred on official duty, that the bills attached are genuine, and that no part has been claimed earlier or from a client. Any amount refundable may be recovered from my salary as per my advance undertaking.

Employee
[Employee Name]
Date: [Date]

Approved by
[Reporting Manager]
Date: [Date]

Finance
[Name]
Settled on: [Date]

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What this template includes

Trip summary linked to the approval or advance number
Day-wise expense sheet by head
GST invoice capture for hotels and air tickets where the company can claim credit
Policy entitlement versus actual to flag excess
Advance adjustment and net payable
Manager and finance approvals

When to use it

On return from an outstation business trip
To settle a travel advance
For multi-city tours with several hotel stays
For training or conference travel approved by the company

How to customise this template

1Add your grade-wise DA, hotel and fare entitlements
2Ask employees to give the company GSTIN to hotels and airlines
3Set a self-declaration limit for expenses without bills
4Include foreign currency columns for international trips

HR tips

Reject expenses above entitlement unless pre-approved in writing
Check that hotel invoices carry the company name and GSTIN where possible
Process settlements quickly to keep employees' float low
Audit a sample of claims each month

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Frequently asked questions

What is DA in a travel claim?+

Daily allowance is a fixed per-day amount for meals and incidentals during official travel, as set out in the travel policy.

Why should hotel bills have the company GSTIN?+

Invoices in the company's name with its GSTIN may allow the company to claim input tax credit, subject to GST rules.

Can I claim expenses without bills?+

Some policies allow small items like local auto fares on self-declaration up to a limit. Check your policy.

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[Company Logo][Company Name]
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)
- Vaccination required for official travel
- Medical treatment during official travel
- Other approved reason: [Details]
Incident or Requirement Details
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[Company Logo][Company Name]
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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[Company Logo][Company Name]
INSURANCE CLAIM ASSISTANCE REQUEST
Company:
[Company Name]
Request No.:
[Reference Number]
Date:
[Date]
Priority:
Urgent (in hospital) / Normal
Employee and Policy
Employee Name
Employee ID
Department
Mobile Number
Policy Type: Group Health / Group Personal Accident / Group Term Life
Patient / Insured Member Name
TPA / Insurer Claim Number
Nature of Assistance Needed
- Cashless approval pending
- Reimbursement claim delayed
- Claim rejected, request review
- Claim partly settled / deductions unclear
- Document query from TPA
- Other: [Details]
Claim Summary
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Patient Name
Relationship to Employee
Age
E-card / Member ID
TPA Claim Intimation No. (if any)

[Company Logo][Company Name]

HOSPITALISATION INTIMATION AND CLAIM FORM

Company:: [Company Name]
Policy No.:: [Policy Number]
TPA:: [TPA Name]
TPA Intimation No.:: [Reference Number]
Date:: [Date]

Note: This internal form helps HR support your claim. The hospital's pre-authorisation request and the insurer's or TPA's claim form must also be completed where required.

Employee and Patient

Employee Name
Employee ID
Mobile Number
Patient Name
Relationship
E-card / Member ID

Admission Details

Admission Type: Planned / Emergency
Hospital Name and City
Network Hospital: Yes / No
Treating Doctor
Diagnosis / Proposed Procedure
Date of Admission
Expected Length of Stay (days)
Room Category Opted
Room Rent Eligibility as per Policy: ₹[Amount] per day

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[Company Logo][Company Name]
PERSONAL ACCIDENT CLAIM FORM (INTERNAL)
Company:
[Company Name]
GPA Policy No.:
[Policy Number]
Insurer:
[Insurer Name]
Internal Ref.:
[Reference Number]
Date:
[Date]
This form supports HR in filing the claim. The insurer's official claim form must also be completed and signed by the insured or claimant.
1. Insured Employee
Employee Name
Employee ID
Designation
Department
Date of Birth
2. Claimant (if not the employee)
Claimant Name
Relationship to Employee
Nominee as per records: Yes / No
Mobile Number
Address
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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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Purpose of Travel
Destination(s)
Departure Date
Return Date
Number of Days
Mode of Travel: Air / Rail / Road
Tickets booked by travel desk: Yes / No

Expense Type: Team Event / Training / Client Gift / Purchase / Other
Description
Business Justification
Date Required By
Number of Beneficiaries / Attendees

Travel Expense Claim

Preview of the form

Employee and Trip

Day-wise Expense Sheet

Settlement

Declaration

What this template includes

When to use it

How to customise this template

HR tips

Frequently asked questions

Claimant Details

Reason for Claim (tick one)

Incident or Requirement Details

Medical Expense Claim Form

1. Employee Details

2. Patient Details

Health Insurance Claim Form

Employee and Policy

Nature of Assistance Needed

Claim Summary

Insurance Claim Assistance Form

Employee and Patient

Admission Details

Hospitalization Claim Form

1. Insured Employee

2. Claimant (if not the employee)

Accident Insurance Claim Form

Employee Details

Trip Details

Cost Estimate

Travel Advance Form

Claimant

Expense Categories

Expense Details

Expense Reimbursement Form

Requested by

Expense Details

Cost and Quotes

Expense Approval Form

Claimant Name
Relationship to Employee
Nominee as per records: Yes / No
Mobile Number
Address

Employee Name
Employee ID
Designation
Grade
Department
Cost Centre
Reporting Manager

Travel Expense Claim

Preview of the form

Employee and Trip

Day-wise Expense Sheet

Settlement

Declaration

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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