anche age atoerst_grftepror NATIONAL HIGHWAYS AUTHORITY OF INDIA ‘Reaties/ Dated... Arar (Name):. 1. UGATH_ (Designation)... Aon daa (Grade Pay); ‘Frater Fr AAPA (Coining Date):....cssee Reimbursement of Telephone/Mobile BEATS / age /SIET aS fra am /fe ten vd ea ‘far TR ‘feurwhy Phone/Mobile/Data card | gitting Cycle/Bill No. & Bill date | Bill Amount (Rs.) Remarks (Be Wee (BR) Total Amount (Rs.) 1 wants Pen onan 8 Ja rated yates & eu gume/atagH a wea # aed al eB) fee AY are Rta /afR-wett & am Hc fora rear 8, ret ae af anna Rar ore & fer avutgecnert grr Ror one ara A ofa gee wa BE AL aL GEN TET AY A ABT aferyAS A es Ar GH) oY Raa emer areas nerafa (at) viet Bh Certified that | have incurred a sum of Rs. (Rupees towards telephone/mobile used for official purpose for the month of _____._As the bill has been Issues in favour of my parents/spouse, this is also to certify that claim made by the undersigned will not be reimbursed from other sources. The admissible amount may be reimbursed to me. Duly certified original/ photocopy(s) of the bills) are enclosed. ‘BRAT Signature: ‘a aTT/Bank Name: HIGUBEREY BS /IFSC Code: ee, wer Eee) A./Extn. Now: » 4 BIA -B./Bank A/c No. (mrtg art By) Av arhaen at gn oR a ar tama yaar ‘Fa wearer fewer at fara Ba Re fever aren Bi arasyeRee, rater saftey aha a aT Biers for At site & surier Sek ger ON ET i aprarar fovan st weak ‘rarer / Accountant werner / Admn,