REIMBURSEMENT OF TRAVELLING EXPENSES FOR CANDIDATES APPEARING FOR

INTERVIEW SCHEDULED ON .
Sr. No. PARTICULARS
1 Name
2 Position Appeared For
3 Department/Work stream
4 Address(Residence)
5 Contact No.

Sr. No. Bank Account Details

1 Payee Name
2 Bank Account No.
3 Bank Name and Branch
4 IFSC Code
5 MICR No.

Sr. No. Particulars of Journey

1 Originating Station
2 Destination Station
3 Ticket No.
4 Airline/Carrier/Train No.
5 Date of Journey
6 Cost of Tickets (Rs.)
7 Cost of Local Transportation (Rs.)
8 Total Reimbursement claimed (Rs.)
9 Total Reimbursement claimed (in words)
(Please attach ticket along with Boarding Passes)

DECLARATION
I hereby declare that the particulars furnished above are true and that the cost of the ticket claimed by me is
the discounted minimum economy class fare and the local conveyance charges are actually incurred by me.

I request that reimbursement claimed may be remitted directly to my bank account detailed above.

Signature of the Candidate

Date: _________________
Recommended and approved that the above Administration Department
candidate be reimbursed for the above expenses BILLS VERIFIED,
incurred by him/her. FOUND IN ORDER &
RECOMMENDED FOR PAYMENT

Signature of Department Head Dy. Manager Approved

(Admin, Liaison & PR) (VP – Admin)
Date: