Annexure A

Cost To Company

Employee Code
Name
Designation
Band and Grade
DOJ
Department
Location/Branch
Date Of Birth
Father Name

Benefits (A) Monthly Yearly

Basic
HRA
Commutation & Conveyance
Allowance
Medical Allowance
Other Allowance
Total A
Reimbursements (B)
Petrol and car Maintenance
Driver’s Salary
Entertainment Allowance
Sudexho Meal Coupons
Medical Reimbursement
Total B
Contributions (C)
Contribution to Gratuity (paid
by emplr)
Contribution to PF
Total C
Total (A+B+C)

In Words- Rs. dddddddd only

Note:
Any tax liabilities arising out of the remuneration will be deducted as per the Income Tax rules.

Mr. ABC
Manager- Human Resources