CENTRE FOR PROFESSIONAL DEVELOPMENT EDUCATION

ANNA UNIVERSITY :: CHENNAI - 600 025.

Claim for Remuneration and Incidental Charges for Teaching / Non-Teaching staff
members for UG / PG (Part-Time / Full-time) Self-supporting programme
Period from ..... to.
Name of the Faculty Member

Designation and Department

Staff ID No.

PAN No.

Name of the Bank and A/c.No.

External Faculty
Designation

Department in which working

Name of the Institution

Residential address with Phone No.

Classes Handled
Name of the Course

Branch

Semester

Subject with code No.

B.E. / B.Tech / M.E / M.Tech / M.Arch / MCA / MBA /

M.Sc (PT/FT)
I / II / III / IV / V / VI / VII / VIII / IX / X

DATE WISE DETAILS OF CLASSES HANDLED

Sl.
No.

Time
Date

From

To

No. of
Hours

Remuneration
Topics covered

Theory
(Rs.)

Incidental Grand
charges
Total
Practical
(Rs.)
(Rs.)
(Rs.)

TOTAL
(Rupees...)

Signature of staff with date

Name of the staff

Signature of Class Advisor with date

Name with seal

Signature of HOD with date

Name with seal