ABCDEFGHIJKLMNOPQRSTUVWXYZ
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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: _____________________________________________
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3. Grade Pay/ Pay level: ___________________________________
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4. Purpose of Journey (with date of meeting):______________________________________
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5. Authority (quote office Order No.): ___________________________________
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DepartureArrivalFromToDistanceMode of JourneyFare (Rs.)Remarks
(Ticket No.)
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DateTimeDateTime
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(A) Total0
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(If travelled by Air, Boarding Pass may be enclosed)
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Food Bills Details (Food bills is to be enclosed):-
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DateBreakfastLunchDinnerTotal
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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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Registration Number of Hotel:____________________________________________________________________________
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Check InCheck OutNumber of DaysAmount
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DateTimeDateTime
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(C) TOTAL0
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DateGrand Total (A+B+C) Rs. 0
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1. Free Boarding Provided: YES/ NOAdvance Received Rs.
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2. Free Lodging Provided: YES/NONet Payable Rs.
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Signature of the claimant
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Received Rs.
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Claimant
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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
Dy Registrar (Accts.)
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DIRECTOR
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