FORMAT FOR TA / DA CLAIM

Name & Designation : ................................................................................................................................................................................................................................

Basic Pay : ............................................................................................................. Scale of Pay ...............................................................................................................
Name of Examination : ...........................................................................................Date of Examination : ...............................................................................................
Nature of Duty : .........................................................................................................................................................................................................................................

Date & Time Place of Journey

Distance Mode of Rate / Incidental DA
Travelled Conveyance Amount Expense for Halt Total
From To From To

Signature with
Name & Designation :