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PROFORMA APRIL 2019

N.W CLAIM FOR THE PERIOD FROM 28 /03 /2019 TO 01/05 /2019 STATION: MC BANGALORE
NAME: DESIGNATION: BASIC PAY : 68100+8160 = 76160 EMOLUMENTS (PAY+DA)
RATE PER HOUR: RS. 381
Period Normal Date Details of extra duties for which OTA is claimed Roster followed during the week
Wk/Endg Duty
(Saturday) Performed From To Hrs NW Total Rate Total Reasons
SUN MON TUE WED THU FRI SAT
During the Hrs of Amount For
Week NW NW Rs. P performing
claimed Rs. P NIGHT
30.03.19 2200 0600 8 1.20 2.40 381 1143 As per duty roster Date 28 29 30 31 01 02 03
03/04/19 02.04.19 2200 0600 8 1.20 ROUNDE
D TO Nor N - E N -
3 HOURS
Ext

Date 04 05 06 07 08 09 10
10/04/19 Nor
Ext

Date 11 12 13 14 15 16 17
17/04/19 Nor
Ext

18 19 20 21 22 23 24
Date
24/04/19 Nor
Ext

Date 25 26 27 28 29 30 01
01/05/19 Nor
Ext

Certified that the details given above by me are correct Certified that I have not claimed any conveyance charges.

Legend: N-Normal duty Ext: Extra duty


Date: Signature of the claimant

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