INDIAN OIL CORPORATION LIMITED

TRAVEL EXPENSES CLAIM FORM ( Single Copy Only ) Travel Period

( Assam Oil Division )

Name : Designation : DEPARTURE Purpose of Journey Date Time Place Date Time Place Salary Code : Basic Rate : ARRIVAL Mileage (Own Vehicle) Chargeable Cost Centre: Place of Posting : Daily Allowance No. of Days Amount (Rs.) Taxi Res/Stn/ Airport (Rs.) Fare -Bus /Rail /Air (Rs.)

Starts From : Ends On: Accomodation Hotel Own/ G.H Total Amount (Rs.)

Sundry (Rs.)

Signature: Date : PARTICULARS OF ADVANCE TAKEN ( IF ANY ) Voucher Ref : Voucher Date: VERIFIED BY Advance Amount : Place of Advance : Reference Data for Claim Daily Allowance Grade A,B C.D E,F Controlling Officer Date : Note: G,H,I 'A' Class 840 900 940 1100 'B' Class 800 840 900 1000 Conveyance 'A' Class 250 300 300 300 'B' Class 200 250 250 250 DFM(Staff) Less: Passed For Payment : Advance Amount Claimed ( Net of Advance ) Figures: Words: ( FOR ACCOUNTS USE ONLY ) AOP No. AOP Date:

Net Amount Paid / ( Refunded ) AOP Apprvd By:

INDIAN OIL CORPORATION LIMITED

( Assam Oil Division ) MISCELLANEOUS EXPENSES CLAIM FORM ( For Claims other than TA/DA )

Name : Salary Code : Designation : Particulars Of Claim ( Supporting Vouchers to be attached )

Date : Place of Posting :

S.No

Amount

Account Code

1.

TOTAL Approved By Head Of Department : Designation : For Accounts Use Only Passed For : Rs.0

Signature : Date :

( In Words ) : Rupees Two Thousand Two Hundred and Ninety Only AOP No : AOP Date :

Signature : Designation : DFM(Staff)