Annexure A-4

Joint Entrance Examination (JEE) Main - 2023 (Jan)

DATED : BETWEEN 24TH TO 1ST FEBRUARY 2023

TO BE FILLED BY OBSERVER AND SUBMITTED TO CC

Centre Code: Name of Centre(s):

1 Name (strictly as per bank record)

2 Observer NTA Test Admin ID

3 Address for Communication
4 Registered Contact No.(s)
5 PAN No.
6 CC’s full name (with contact no.) ANJALI MALIK- 9868308210

7 RC’s full name HARAMOHAN ROUT - 9412708283

8 Bank Name and Branch
9 Bank Account No.
(As per bank record in full digit)
10 IFSC Code (As per bank record in full digit)

I hereby certify that as per appointment letter, I have received below mentioned payments from CC, for
examination duty during Joint Entrance Examination (JEE) Main - 2023 (Jan)

S.no. Details Duty Payable Amount Received Bank Name Bank transfer
Reference number
Date day/s on
s
Remuneration
1) @3600/- day (Rs.
4,000 – 10% TDS) as
per duty days.
Mock Remuneration
@1800/- day (Rs.
2,000 – 10% TDS) as
per duty days.
Fixed local Conveyance
2) @1000/- day

Fixed Food Expense -

3) @300/- day
TOTAL AMOUNT RECEIVED

………………………… …………………………….
Signature, ID & Seal of City Coordinator) (Signature and ID of Observer)