Declaration Format-A

I Ms Mude Priyanka, Roll No.. a student of 3rd Year Engineering of

Shree Vidyaniketan Engineering College, Ananthpur, do hereby
declare that I have incurred an expenditure of Rs 10,000/-(Rupees Ten
thousand only) towards purchasing of books & stationaries etc related to
my study during the year 2015-16 and I have not kept any vouchers
towards this.
I request Tata Housing Development Company Ltd to reimburse the same,
in good faith, at an early date.

Date

(Signature)