I. K.

GUJRAL PUNJAB TECHNICAL UNIVERSITY

Jalandhar- Kapurthala Highway, Near PushpaGujral Science City,
Kapurthala-144603.

Honorarium
1 Name (In Block Letters) 2 Father Name

3 Address 4 Contact No.

5 Designation 6 Organization

7 Pay Scale/ Consolidated 8 Grade Pay

Salary

9 Date of Meeting/ Inspection 10 Purpose of Meeting &

Journey

11 Last Pay Scale & GP if 12 E-mail ID

Retired

13 Bank A/c No. (For ECS 14 Bank IFS Code

Payment)

15 Bank Name/ Branch 16 PAN No.

(A) Honorarium: -
No. of Rate of Honorarium Total Amount
S.No. Particulars Date Candidate (Only for experts) (Rs.)

Please add additional form if required Total:- 5000/-

Grand total of A: ________________

Certified that: -
(i) Particulars provided herewith arecorrect&that I have not claimed TA/DA for this Journey from any other Public Source and bill is submitted first time.
(ii)I was not provided free lodging and/ or Boarding at the cost of Govt./University Govt./ or any autonomous body if provided please
attachBoarding/Lodging/Both Bills.
(iii) Certified that I shall perform the returnJourneyfrom ___________________ ______________________ _ Class.
___________________ to_____________________ in_______________________
(iv)Certified that the I have traveled byshortest route and I will perform return Journey by same route and……………….……… mode of conveyance/as
claimed and………………………..mode of conveyance
The above Meeting/Journey claim is verified to be true &correct.
affix
revenue
stamp
For Receipt
Above
Rs.5000/-
Verified by:-

Signature of Claimant

Deputy Registrar (R&D)

For Use by Accounts Office Only

………………………………………………………………….……………………………………………………………………………………………………………………………..

Rs ___________________/-
Head of Account:-____________________Passed for Rs.
or return in original with remarks as attached.

Dealing Clerk/SA Assistant Registrar Dy. Registrar Finance Officer