O& corectter siettfirest Seer areret Indian institute of Technology Guwahati Sena FormNo. Geno ____Contingency Expenses Reimbursement Form “Contingency” Ale Code ofthe concerned academic Dept (Centre: Name of claimant (in BLOCK letter: — Programme (Please tick (7): M.Tech. Des Ph. D/ Dual (. Tech + Ph.D) 1 2 3 4. Roll No. 5. Department / Centre: 6 7. 8 9. Session: Contact Phone Now email: _ [Amour of relmbursement (Maximum Rs. 5,0007- per annum) 10. Bank Alc No. ofthe claimant: 11. Name and Branch of Bank: ‘Description of ems St.NO. | (voucher No.) Total Expenditure Woter + To be submitted on one-ime-basts onby latest by the month of February fore Tnencal year (@upecs only) Signature of Csimant Certified thot the reimbursement claim has been done on onetime bass for financial year Recommended / Not Recommended HOD / HAC (vouchers / Bls Cash Memos ae tobe attached chonologicaly with ctf testtionby the Cenant ETAL 12, Whether the above referred person fs 8 MHRD funded registered “Regular” M.Tech/M.DesPh.D /Dual (Tech + Ph.0) student or not? (Yeso} Ho the status Is Dealing Assistant RY AR head.) DORA, ADOAA TAIT (Checked and passed for poyment of rupees cai Towards the dal Dealing Assistant ‘Accounts officer (F6.) ‘ARI ORUFEA) REGISTRAR /DIRECTOR