LPSC VALIAMALA / एलपीएससी वलयमला

CLAIM FOR TRAVELLING EXPENSES OF CANDIDATES CALLED FOR INTERVIEW / SKILL TEST

01 Name of the candidate (in Block letters) :

02 Name of the post :

03 Date of Interview/Skill test :

04 Address given in the application for :

correspondence

05 Mobile Number and Email ID :

06 Particulars of Railway/Bus journey :

performed to appear for Interview/Skill
Test
a) Started from (Railway/bus Station) :
b) Journey commenced on :
c) Class in which travelled :
d) Ticket No. :
07 Whether concessional return ticket was :
produced
08 Amount of the ticket fare paid :
09 Whether Bus/Rail tickets
:
attached/produced in respect of journey by
road/rail
BANK ACCOUNT DETAILS
10 Account Number :
11 Name of the Account Holder with
:
relationship with the candidate
12 Name of the Bank :

13 Branch Name & Address :

14 IFS Code :
I certify that the particulars given above are correct and that I performed the journey by ………..……class by Rail
accommodation/bus as mentioned above. I also undertake to perform the journey by the same class and to the Railway
Station mentioned in item 6(a) above. Please reimburse the amount admissible to me.

Date: Signature of the Candidate

FOR THE USE OF RECRUITMENT SECTION
Certified that Shri/Smt./Kum. ……………………………………………………..…………. is attending Interview / Skill Test
for the post of …………………………………………………………………………………………on …….…………………….
and his/her TA can be paid on completion of Interview/Skill Test.
Date: Controlling Officer
 FOR THE USE OF ACCOUNTS SECTION

Passed for payment of Rs …………………….. (Rupees …………..………………………………………………………)

Debit ……………………………………………………………………………………………….

Date: Accounts Officer

RECEIPT
Received the amount as passed above in full settlement.

Date: Signature of the Candidate