Zone-A, 7th Floor, Fortune Towers, Chandrasekharpur, Bhubaneswar, Odisha, India Phone : +91-674-2303765-66, Fax : +91-674-2303755-56 Website : www.opgc.co.in

APPLICATION FOR REIMBURSEMENT OF TRAVEL EXPENSES To, Head HR OPGC Written Test Venue: ______________ Post Applied for: ___________________ Dated: / / 2013

Name of the Candidate: __________________________________ Roll No: __________________ Address: _________________________________ Contact No.: ____________________________ ___________________________________Email Id: _______________________________ ____________________ Pin No. ____________ Details of Travel: Train/Bus Journey Date of travel From Station: To Station: From Station: To Station: Total Rupees a) Attach: b) Attach: Original/Photocopy of Rail/Bus Ticket/Receipts towards proof of journey. Copy of Caste Certificate (as applicable) DECLARATION BY THE CANDIDATE I hereby declare that the information given above is true and any false information will render me liable for non-payment of travel expenses. Place: Signature of Candidate

Mode of Travel Rail/Bus

Train Name, Class of Travel

Travel Fare (Rupees)


Reimbursement of Travel Expenses will be made for 2nd Class rail/Bus fare by the shortest route to the examination centre for outstation SC/ST candidates on production of copy of ticket of one way. No Local Conveyance charges will be admissible. Please hand over this form duly filled along with the attachment as mentioned above at the examination center before the start of the examination.

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