APPLICATION FORM FOR REIMBURSEMENT OF TELEPHONE/MOBILE/BROAD BAND CHARGES

PART-}
(To be filled by the Officer claiming reimbursement)

Ad m i s s i b l e amount claimed f o r Landllne/M oblie/Broadband charges >

Certified that ail calls during the above period were made for discharging official duties and were in the
public interest. Also certified that the bills do not include ISD calls. The bills, in original with call details, are
enclosed for reimbursement.

Dated: …………………… Signature

PART-II
(To be filled by Administration Branch-ll)
B&P Branch may please find enclosed above bills for Rs.________ regarding
reimbursement of Telephone/ Mobile/ Broadband charges submitted by
Shri/Smt./Ms. ______________________________ _________ ." After scrutiny of the claim, the admissible
amount comes to Rs. ___________ for payment.
CERTIFIED THAT:
(1) Necessary entries have been made at Page No. ______ SI. No._________ in the Telephone Bill
Register.
(2) The Bill(s) is/are in order and may be paid by B&P Branch. Steps have been taken to ensure that
double payment is not made on this account.
(3) Sanction to Incur an expenditure amounting to Rs. ___________ has been obtained from the
Competent Authority vide note dated ___________.

B&P Branch HEAD OF THE BRANCH/UNDER SECRETARY

P.T.O>
 PART-III
(For use in Bills & Payment Branch)

CB No. ________________ dated ______ passed for Rs. ________ for payment.

The expenditure on this account is debitable to:

2011 - Parliament 102 - Lok Sabha
Secretariat 01 - Secretariat
010013-Office expenses.

DRAWING AND DISBURSING OFFICER

PART-IV

(For use in Pay & Accounts Office, Lok Sabha)

Entered in E.C.R. on (date) ___________Examined and admitted for Rs. ____

Objected to Rs.