Name Designation Division Headquarters Pay Vr.

no date

Particulars Of Journey And Halt Journey By Railways Journey By Road Daily Allowance

Journey Purpose of
Kind of
Journey
Remarks
Total

Date Date
Departur Arrival
e Hour Hour Class No. of Amount No. of Rate Amount No. Of Rate Amount
Fares Miles Days

Passed for Rs . Received Rs . Deduct Advance

 Net Claim

Controlling Officer Wapda Accountant Signature of Payee Signature