Total of

Departure Arrival Km/ Daily Allowance Amount

Rate Line
/ Actual Hotel
Date Date Mode Class Fare Charges No.
Rate
Station & Station & of of paid (If Any) Of
Travel Admissible
Hour Hour travel Days

1 2 3 4 5 6 7 8 9 10 11 12
G.S.S.S 08/11/2019 08/11/2019
7:00 am
Kunihar
10:00 am
By Bus - 74/- -- --- ---- --- 74/-
Ghariach
08/11/2019 G.S.S.S 08/11/2019
Kunihar
5:00 pm 7:30 pm
- 74/- 1 day 180 180 254/-
Ghariach
G.S.S.S 14/11/2019 14/11/2019
7:00 am
Kunihar
10:00 am
By Bus - 74/- -- --- ---- --- 74/-
Ghariach
4 Days@180
Halt at Kunihar W.E.F. 14/11/2019 to 17/11/2019 (4 Days) (180*4=720) 720 720/-
18/11/2019 G.S.S.S 18/11/2019 1 Day @
Kunihar
9:00 Am 1:00 Pm
- 74/- 1 day
58(70% 84)
58 132/-
Ghariach

296/ 1254/onl
**GRAND TOTAL** only
-------------------------------------- 958/
y

H.P.T.R -7

TRAVELLING EXPENSES CLAIM FORM

Establishment
1. Principal G.S.S.S Ghariach Month (November) Year 2019
2. Name & Designation Sanjay Raghuvanshi (P.G.T-I.P)
3. Basic Pay 10740+5400 Head Qrs. GHARIACH
4. Purpose of journey To Conduct Panchayat Election

(Details of the Claim)

1. Total of Column No.12 (B.F) Rs 1254/- ONLY

2. Terminal Transportation Charges Rs N.A
3. Local Transportation Allowance Rs N.A______
4. Transfer Grant Rs N.A______
5. Personal Effects
Wt._____________Rate ______________Amount Rs N.A______
6. Conveyance Charges Rs N.A______
7. Miscellaneous (Specify)______________ Rs N.A______
8. Gross Amount Rs 1254/- ONLY

9. Less Advance of TA/TTA Drawn Vide

T/V No________________Dt__________ Rs N.A_______
10. NET AMOUNT PAYABLE Rs 1254/-ONLY

(Signature of claimant)

Passed for Rupees. One Thousand Two Hundred and Fifty Four Only (Rupees)

(Signature of Controlling Officer) (Signature of D.D.O)

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

(TO BE USED IN AUDIT OFFICE)

Admitted for Rupees. ________________________________
Objected to Rupees. ________________________________
Reason for Objection ________________________________

(Accounts Officer)

INSTRUCTIONS
1. Tour Diary should invariably be attached with the claim.
2. In case of Transfer claim, the details of members of the Family with age along with details of personal effects be given.
3. The Receipt Nos. of Hotel and Carriage bills be quoted against the relevant column.
4. Ticket Nos. should be quoted ,when journeys are performed in a class Higher than the ordinary class

____________________________________________________________________________________________________________