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,-- ·------------­

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DEP pJ~TM:ENT OF TELECOMlvfU!0\C:s.Tl:JJ·E

( CASH SECTION l

REIM:BURSEMEf.:T OF NEWSPAPE!c CLAIMS VIDE EMP.NO - - - - -

DOT ORDER N0.3-12/94-LIB.DATED 4 12 1994 &
20.8. l 997 VIDE MIN1STR Y OF FIN.l\NCE ORDER "10 NAME _ _ _ _ _ _ _ __
F.1(16)-E-Il(A)/94 DATED 13 09 l 996
DESGN - - - - - - - - - - - -
TEl..-E.PHOlJE. No. ______
CLAIM FOR THE QUARTER ENDING_ _ _ _ _ _ _ _ _ _ _ _ _ __

LEVELOFOFFJCER SO/DOIU S/ADG/DIRECTOR'JTO/AA01 AO/ENGINEER/AV-' A/DW Ai AD

M.AXIMln\~ L!MJT OF l!\'DlAJ'-1 N'EWS!'Al'EK ON£

(CLAIM TO BE PREFERRED QUARTERLY FlY l 5"' JAN/ls'" .l\PR/l 5 11 '.IUL!l 5'1' OCTOBEF.)

SL NAME OF NAME OF NEWSP.l\PER MONTH AMT REIMBURSEMENT

NO.NEWSPAPER AGENT & ADDRESS PAID AFTER
DEDUCTfNG l 5%

CERTIFICATE

Certified that the Newspaper(s) mentioned in the claim were actually received by me at
my residence
2. Certified that the rates charges in the bill are correct
3. Certified that J have not submitted any other claim for the above QUARTE:Z(S;
4 The bills in original from the Vendor/Newspaper Agent are enclosed.
5 RESIDENTJAL ADDRESS

I WAS POSTED/JOT1''ED fN DOT RETIRED FROM DOT(HQ)AS_ _ ON - - - · _

SlGNATURE OF CLAJMNT

( FOR THE USE OF CASH SECTION )

PLEASE PAY Rs. - - - - (RUPEES_ _ _ _ _ _ _ _ _ __ ONLY)

SECTION OFFICER( CASH )