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BILL FORM FOR THEORY/PRACTICAL EXAMINATION

Tick ( ) which ever is relevant


Practical Theory Examination held in___________________

1. Name 2. Designation

3. Basic Pay 4. Institute/Department/Retire 555.

5. Address on which payment is to be sent


(one self addressed envelope to be attached)

6. Particulars of work done: From __________________ To _______________ No of days ___________________


A) Honorarium
Shift No. Of
S.NO Date Subject Class Rate Amount
M E Students

Total Honorarium Amount

B) T.A. a) i) Bus/Rail Fare from_______________________to____________________ Rs._____________


from_______________________to____________________ Rs._____________
ii) Local Conveyance (Strictly as per Punjab Govt. Rules)
Mode of journey Kms Rate Amount

Rs._____________
b) By Taxi/Car
i) By Taxi
ii) By Own Car
iii) By Other means
Rs._____________
Please mention your Taxi/Car No._____________ Total T.A ____________
Note: Specify No. Of Kms with (rate per kms) as per untitlement
C) Any other expenses (Detail to be given) Rs._____________
Grand Total (A+B+C) Rs._____________

Date:
Verified by the Principal Signature of Claimant

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