ANNA UNIVERSITY CHENNAI -EXAMINATIONS-Apr/May, Nov/Dec/Jan 20___

ANNA UNIVERSITY REPRESENTATIVE CLAIM FORM w.e.f.5 may 2009

Name of the AUR : …………………………………………………….. Designation : ………………………… AUR
Colleg Name & Code ( Working ) : ……………………………………………………………………………… Vr.No.
Period of Examination : From : ………………..... To : ………………….. Name of the Zonal Office : Zone-VIII,GCE,SALEM.
Details of Anna University Representatives
A/C HOLDER NAME ACCOUNT NUMBER IFSC CODE PAN NUMBER MOBILE NUMBER

Lump sum Allowance to

No of sessions
Remuneration for incidental Expenses (Rs.
TDS -10% in Total Amount
Name of the Institution (abbreviated) & code No. AUR ( Rs. 200/- 300/- per session subject to
S.No Date of Exam Remuneration (Rs.)
to which deputed as AUR per session ) a maximum of Rs.350/- per
(C=A/10) (A+B-C)
(A) day)
(B)

TOTAL

TDS(10%) PAYMENT ( X )

AMOUNT TO BE PAID ( Z )

TOTAL PAYMENT( X+Z )

Grand Total : Rs………………….(Rupees……………………………………………………………………………………………………………)

Post Held Signature

Signature with Date
Zonal Officer
(Affix Revenue Stamp if amount exceeds Rs.4999)