STEEL AUTHORITY OF INDIA LIMITED

BHILAI STEEL PLANT

RECRUITMENT SECTION

TA Claim-cum- Receipt Acknowledgement Form

1. Post for which called for Interview
2 Category and Special Category Category Special Category: ESM/PWD
3 Reg. No. Reg. No.
4 Name of the candidate
5 Date of Interview
Journey from (Address)
6 Village/Town/City
Nearest Railway Station
7 Place of Interview Bhilai Niwas, Bhilai
8 Date of Departure
9 Date of Arrival
10 Distance Travelled
Mode of Travel
11 Rail/Bus
Ticket No. & PNR No./ Bus Ticket No.
12 Actual fare for inward journey Rs.
13 Actual claimed for return journey Rs.
Total Amount claimed Rs.
14
Total Amount claimed (in wards)
A/c Number :
Bank Name:
15 IFSC Code:
Bank Document submitted Front page of Bank Pass Book
Certificate by the candidates:
Certified that I have actually undertaken the journey as per the details mentioned above. It is also certified that I
intend to undertake the return journey in the similar mode as my inward journey.
The details of Bank A/C mentioned above are my own and BSP shall not be responsible for non payment of TA due
to error in the bank details mentioned above.
Signature of the candidate
Contact No:
Certified that the above mentioned candidate was called for Interview for the post mentioned above and has
attended the Interview.

Signature by Verification officer/Staff