CERTIFICATE I certify that for the month of Thave used my personal car bearing registration Number registered in my name for the official purpose and I have incurred an amount of Rs. for performing solel official journeys. This amount may kindly be reimbursement. T further certify that more than 15 days /30 days a) [was on leave or on tour for the period less th consecutively during the month b) Iwas on LWP / EOL for days. # c) Incase the above reimbursement amount comes under purview of tax, the same shall be on my account. # Strike out if not applicable. Signature of the Officer: ‘Name of the Office: Dated: