ANNEXURE-II(Revised)

DATE :…………….
REQUISITION FOR TOP UP OF STATION ACSESS CARD (SV-4)

Name of Staf Design& Project Engr.CSC No. Place of Whether official vehicle is Whether Entitled Date & Value of last Top-
Employee Emp no O&M deployment provided /using own provided Top Up card
Line/ vehicle under new with CDA/ upvalue
station/Depot/ transport policy (For conveyan (Rs)
MB executives only) ce
allowance

Before TOP UP remaining value = Rs. ………..

Value to be added = Rs. ……….
Value after top up Rs………….

Declaration
I hereby certify that I am eligible for TOP-UP of Rs………. Per month and had the last TOP UP of SV-4 card done on the date mentioned above and there has been only one
TOP-UP during …… (MM/YYYY).

Signature of Employee ……
Name of the Employee……
Designation ……………………
Employee No.
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For CCC use only
Before TOP UP remaining value = Rs. ………..
Value added Rs. ……….
Value after top up Rs………….
Voucher No. generated Slip attached

Sign of CC operator …………….. ……………………

Name of the CC operator ……………………..
. Designation ……………………..
Employee No. ………………
NB: Concerned CCC staffs are required to keep and maintain the record of requisition of TOP-UP.