IndiaFirst Life Insurance Company Ltd

301, 'B' Wing, The Qube ,

Infinity Park, Dindoshi - Film city
Road,
Malad (East), Mumbai - 400 097

T +91 22 39418700
F +91 22 33259500

www.IndiaFirstLife.com
Think New Be Helpful Be Honest Do More




Confidential The information contained in this communication is confidential. Unauthorized use, disclosure or copying is strictly prohibited and may be unlawful.


Telephone Landline Expenses Flexi Benefit-Reimbursement Form

Employee No. :____________________ Mobile No:_______________

Name: ______________________________ Location: ________________

Please reimburse me the following Telephone Landline expenses incurred during the

Period _________________to _________________as per Company's Rules:

A.
Sr.
No. Bill No./Date Name of the person Amount Service Provider






Declaration:

Please note the following:
- The Bills have to be attached with the claim form.
- Employee number and name is mandatory.
- Bills pertaining to current financial year will be processed.
- Bills will be processed with effect from the date of joining.
- Bills from the PCO booth will not be processed.
- Please staple the bills at the back of this form.


I hereby declare that all the information given by me is true and correct.
Any Income Tax liability arising out of a wrong declaration will be my responsibility, and I undertake to
indemnify the Company and its officers from all consequences, monetary and otherwise, arising out of
any incorrect and/or incomplete information provided in this declaration

Signature: _____________________

Date: _________________________