Name of the FE / FS: ______________________________________________ Date: ___________________

Name of the A/C: _________________________________Name of the GP / Ward: ___________________________

VOUCHER – A
(Boarding Claim)

Amount Spent on Amount Spent on Amount Spent on Amount Spent on Total Amount
Break Fast Lunch Dinner Other Purposes Spent
Rs. Ps. Rs. Ps. Rs. Ps. Rs. Ps. Rs. Ps.

VOUCHER – B
(Travelling Claim)
Mode of Amount Spent
Total Amount
Distance Conveyance on Local
S.No From To Spent
(KMs) Auto/Bus/ Mobility
Motor Cycle Rs. Ps. Rs. Ps.

Total Amount of Boarding Claim: Rs. Total Amount of Travelling Claim: Rs.
Grand Total of the Claim: Rs. /- (in words: )

PAYMENT VOUCHER (For Office Use Only)

Received Rs. ____________/- with thanks from Identcity consultants Pvt. Ltd. towards the boarding

and travelling expenditure incurred during the survey today.

Name (in Block Letters): Signature with date:

Designation: Mobile. No: