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विश्वेश्वरय्या राष्ट्रीय प्रौद्योगिकी संस्थान, नागपुर.
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VISVESVARAYA NATIONAL INSTITUTE OF TECHNOLOGY, NAGPUR
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TA / DA CLAIM FOR OFFICIAL TOUR / DUTY
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1. Name of the claimant: _________________________________________________________________________
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2. Designation: ______________________ 3. Dept: _________________ 4. Grade Pay/Pay Level ________________
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5. Purpose of Journey (with date of meeting):
______________________________________________
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(Enclose Financial Approval and Office Order)
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Journey Details (Bus/Rail/Air Tickets, Local Taxi etc to be enclosed) :-
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DepartureArrivalFromToDistanceMode of JourneyFare (Rs.)Remarks
(Ticket No.)
Foreign currency and conversion rate (If Any)
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DateTimeDateTime
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0
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0
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0
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0
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0
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0
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0
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(A) TOTAL0
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(If travelled by Air, Boarding Pass may be enclosed along with ANNEXURE 'A' UNDERTAKING)
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(ANNEXURE 'A' UNDERTAKING (To be submitted in all cases of air travel where the Govt of India bears the cost of air passage))
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Food Bills Details (Food bills is to be enclosed):-
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DateBreakfastLunchDinnerTotal (Rs.)Foreign currency and conversion rate (If Any)
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0
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0
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0
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0
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(B) TOTAL0
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Hotel Details (Hotel receipt is to be enclosed):-
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Name of Hotel: ____________________________________________________________________________
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Check InCheck OutNumber of DaysAmount (Rs.)Foreign currency and conversion rate (If Any)
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DateTimeDateTime
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0
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0
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0
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(C) TOTAL0
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OTHER DETAILS:
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S.N.PARTICULARSAmount
(Rs.)		Foreign currency and conversion rate (If Any)REMARKS
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CONFERENCE FEES0
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VISA FEES0
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INSURANCE FEES0
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(D) TOTAL0
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(Please enclose bank/credit/debit statement if paid in foreign currency)
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SUMMARY OF (A+B+C+D):
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S.N.PARTICULARSAmount
(Rs.)		REMARKS
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1TRAVEL EXP.0
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2FOOD EXP.0
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3HOTEL EXP.0
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4CONFERENCE FEES0
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5VISA FEES0
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6INSURANCE FEES0
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(E) TOTAL0
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Date:Grand Total (E) Rs. 0
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1. Free Boarding Provided: YES/ NOAdvance Received Rs.0
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2. Free Lodging Provided: YES/NONet Payable Rs.0
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Signature of the claimantReceived Rs.0
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FOR OFFICE USE (ACCOUNTS SECTION)
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A/c Head _____________________________________________
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Checked and correct, amountVerified & found Correct
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Payment Rs.: _____________________Rs. : ___________________ may be paid
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Dealing Clerk / Assistant
IAO
Jt. Registrar (Accts.)
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DIRECTOR
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