INDIAN INSTITUTE OF TECHNOLOGY BONIBAY

(at new rates 6'h cpc) To be filled by Admn. Section

Sr. No. of TA Inward Register
Date of Receipt

NAME: DESIGNATION: Salary Code:

Grade Pay: Rs.
Amount of Advance drawn, if any : Rs.
Ceoified that I was on tour from (dt.) to (dt.) for the purpose of
and that I traveled
by the class and mode of conveyance as indicated

below:
1. Claimed fares (Air/RatBus):
Depanure Arrival Mode of Journey Class of PNR No.(if Fare in Trail
Rail Road Rail / Journey applicable) R.. Flight No.
Bus Air/Rail Bus
Place Date & Time Place Date & Time

2. Details of Local Conveyance charges incurred:

Date Station Place visite aveled Distance Mode of travel Fare in Remarks
T Auto Rs.
From To

3. Hotels/Guest House charges incurred

5tatio Name of HotelPeriod of Stay No. of Mode of Remarks

n Days TAutoRs.
travel
4. Reimbursement of Food 8ills

Sr. No. Date Amount in Rs. Sr. No. Date Bill Details Amount in Rs.

5. Further paniculars required to be furnished Replies

a i) Whether you availed of Saturday,Sunday & holidays or any leave during

the days of halt? ii) If yes, please give details about the period and date:

b Ii Whether the EA. is to be borne by IIT Bombay/ProjecUAny other Budget Head:

source? Please give Expenditure Budget Head. if applicable:

6. Summary of Claimed Amount : in Rs. To be completed by the Official To be filled by Office

i (a) Fare
(b) Conveyance Charges
(c)HoteF'Accommodation Charges
(d)Fo Boarding Charges
(e) Other claims (details to be furnished)
Total
Less:Advance Taken on dt.:
Net Amount

Countersigned

DIRECTOWDEAN (R & D) / REGISTRAR H.O.D.

Forwarded herewith T.A. Claim for necessary action

Admn.
To : Accounts Secñ on
Admitted for Rs.

for Rs.

Disallowed / Added Rs.

Asstt. Registrar
(Audit)

Passed for Rs.

(F & A)