Reimbursement Declaration With Car Lease FY 2026-27 Please enable JavaScript in your browser to complete this form.Employee ID *Employee Name *Employee Email *Reimbursement Declaration Driver SalaryDriver Salary (Maximum amount is ₹25000 per month) *YesNoSpecify Driver Salary for per month in words (Maximum amount ₹25000 per month) *Specify Drivers Salary for per month in figures (Maximum amount ₹25000 per month) *Fuel AllowanceFuel Allowance (Maximum amount ₹25000 per month) *YesNoSpecify Fuel Allowance for per month in words (Maximum amount ₹25000 per month) *Specify Fuel allowance for per month in figures (Maximum amount ₹25000 per month)Car Maintenance & Service Car Maintenance & Service (Maximum amount upto ₹4167 per month i.e. ₹50000 per annum) *YesNoSpecify Car Maintenance & Service for per month in words (Maximum amount upto ₹4167 per month i.e. ₹50000 per annum) *Specify Car Maintenance & Service for per month in figures (Maximum amount upto ₹4167 per month i.e. ₹50000 per annum) *Telephone & Broadband AllowanceTelephone & Broadband Allowance (Maximum amount is ₹5000 per month) *YesNoSpecify Telephone & Broadband Allowance for per month in words (Maximum amount ₹5000 per month) *Specify Telephone & Broadband Allowance for per month in figures (Maximum amount ₹5000 per month) *Books & Periodicals Allowance (Applicable only to old regime)Books & Periodicals Allowance (Maximum amount ₹5000 per month) *YesNoSpecify Books & Periodicals Allowance for per month in words (Maximum amount ₹5000 per month) *Specify Books & Periodicals Allowance for per month in figures (Maximum amount ₹5000 per month) *I agree that the final amount of contribution will be decided by the HFS Payroll team. *YesI agree that my Annual FBP plan shall not exceed 6 lacs *YesSubmit
