DR.

RAM MANOHAR LOHIYA NATIONAL LAW UNIVERSITY, LUCKNOW

MOOT COURT COMMITTEE (M.C.C.)

MOOT REIMBURSEMENT FORM

Name of the Competition-……………………………………………………………………………….

Allotted through (Please tick) – UMCS / Navitas / Concours / University Open Challenge
Team Composition:
S. No. Name Semester, Year Mobile No. Signature
1.
2.
3.
4.
5.

Details of Travel:
Departure
From: Mode of Travel: ..……………………………………………………
To: P.N.R. of Ticket(s): …..………………………………………………
Arrival
From: Mode of Travel: ..……………………………………………………
To: P.N.R. of Ticket(s): …..………………………………………………

Details of Registration:

Registration Amount Paid:

Mode of payment (Please tick): Transaction Id (if any)-

Cash/Cheque/DD/Online Transfer ………………………………………………….

Account details of the person to whom the reimbursement is to be made:

Account Number Name of the Account Holder

Bank/Branch IFSC Code

-For Office Use-

Attachments:
1. Merit Certificate(if any) - Applicable for 60% or 100% reimbursement (60/100) ………
2. Tickets of all Participants (Yes/No) ………
3. Receipt of Registration Money (Yes/No) ………
____________________________
4. Participation Certificates of all Participants (Yes/No) ………
(Recommendation of

Amount to be Reimbursed: Convenor/Treasurer, M.C.C.)

Actual Expenditure on Travel Corresponding 3AC Fare

(Recommendation of Chairman,
Registration Fee Total Amount Reimbursed
M.C.C.)