OFFICE OF THE CONTROLLER OF EXAMINATIONS

CLAIM FORM FOR QUESTION PAPER SETTING – Feb. 2021

Ref. No: Date: / /2021

Remuneration Per
Sr.No Question Paper

Paper(s)
Question
UG/PG/
Diploma

No. of
Programme & Branch, Semester, Rs. 500 – UG / Total Amount
Course Code & Title Rs. 700 – (in Rs.)
PG/Ph. D.
Rs. 400-Diploma

Total Amount (in Rs.)

(Received a sum of Rupees ....................................................................................................................... only.)

Name :
Designation/Dept. :
Univ / College Name : Affix one

Mobile No : rupee revenue

stamp if claim
E-Mail ID : exceeds
Experience : Rs.5000/-

Staff ID:
Signature
CLAIM PAYMENT DETAILS (Other than SUN)

Bank Account No :
Name of the Bank :
IFSC Code :
Branch :
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