REQUEST FORM FOR EMPLOYEE ADVANCES / IMPREST CASH / LOANS To be updated by Request / Received Date Employee Name &

Designation Approving Superior & Designation ** Employee Code as per HR / Finance BU / Division represented Function / Department Location New / Amendment Request Employee HR Finance

SUDDHASATWA MUKHOPADHYAY SAURAV BHATTACHARYA (BM East) 1152 IS Transmission Tower Line (ENICL Project) Jalpaiguri Request for imprest

Amount Requested towards Amount Requested E.g. INR 10,000 /- or US$ 500 /Estimated date of settlement (1 week within completion of purpose for expenses advances) State detailed purpose of requesting amount In case of Travel state place of travel, estimated duration of stay, purpose of travel / In case of others kindly mention relevant details

5,000.00 INR FOR THE MONTH OF DECEMBER 2013 5,000.00 INR

Settlement will be done within ONE WEEK after receiving the amount. (Balances will be reviewed for settlement / renewal / confirmation at every year end at December) . ADVANCE NEEDED FOR FUELING OUR ONE NUMBER SCORPIO CAR WHICH IS USED FOR OUR SITE VISITING PURPOSE (JALPAIGURIFALAKATA SECTION)

Signatures / Approvals ** with date Employee

Approving Superior (as per Intertek authorisation matrix) Approved for HR (For Imprest Cash & Loans) (mention name & designation) Approved for Finance (for Accounting & Control) (mention name & designation)

** The approved request form should be retained with the payment voucher; in case of requests for loans & imprest, the approved form in original should be retained with HR in the employee file & a copy should be retained with the payment voucher;

Intertek India Private Limited

E-20, Block-B1 Mohan Co-operative Industrial Area, Mathura Road, New Delhi - 110044 Tel: +91 - 011-41595460 , Facsimile: +91 011-41595475