APPLICATION NO. …………………….

APPLICATION FOR REIMBURSEMENT OF FARE PAID BY THE CANDIDATE

CALLED FOR APPEARING IN INTERVIEW FOR THE POST OF ____________________

1. Name of the Candidate : __________________________________________

(in BLOCK Letters)

2. Permanent Address : __________________________________________

(as filled in the Application Form) __________________________________________

__________________________________________

3. Correspondence Address : __________________________________________

(as filled in the Application Form) __________________________________________

__________________________________________

4. Travel Details (Please attach the copy of tickets/boarding pass)

Date From To Mode of Travel Class in Ticket No./ Fare

(Place) (Place) (Rail/Bus/Air/ which PNR No. Paid
Auto/Taxi) travelled

Total Fare Paid (in Words) ________________________________________________________

Certified that the above information furnished by me is correct.

Please pay the admissible TA amount into my Bank A/c No. ______________________
(Bank details enclosed)

Date: Signature of the Candidate

…………………………………………………………………………………………………………

Signature of HR Officer

Please pay Rs. ……………………………………………. (Rupees ……………………………

…………………………………………………………………………………………..)

Dy. Manager (F&A)/ Manager (F&A)

To

Cashier