(A) Performa for Attendance sheet

1-Name of the consultant: Syed Ishan Ahmed

2-Name of the hospital:District Hospital Gonda
3-Designation:Hospital Manager
4-Attendance of Consultant for the Month of – January 2019

Attendance Sheet
Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Status P A P P P W P P P P L L W P P P A P P W P CO P P P GH P P W P P

P-Present; H-Holiday; A-Absent; L-Leave

Total No. of Present:
No. of leaves, if any :

VERIFIED BY

(Signature with seal)

Director/SIC/CMS of Hospital
(B) Performa for Bill

Name of the consultant: . Syed Ishan Ahmed Address:418/145,thakurganj, Lucknow

Designation:Hospital Manager Mob: 9312154950
Name of hospital:District Hospital Gonda
Bank & Branch Name. SBI, chowk Branch PAN No- ANNPA5576H
Bank A/c No. IFS Code- ………………………………….
Project Director, Bill No- ……………… /2015-16
U.P Health Systems Strengthening Project,
SIHFW Campus, C-Block, Indira Nagar, Lucknow (U.P) India
Pin:- 226016 Date: …………………..(DD/MM/YYYY)
S.No. Description Rate (Fix) Amount in Rs.
Consultant fees for the month of ………………….. as per above @Rs. per Month
1- mentioned Attendance

TOTAL

( Rs. In words only)

Kindly release the payment at the earliest.

Thanking You,

Signature of Consultant -……………………………………..

E&OE Name of Consultant……………………………………..