Local Conveyance Form
Name: Employee Id:
Designation: Level at the Instittue:
Department:
Mode of
Place Place Amount
Conveyance Purpose of Visit
(Bus/Three and Source of
Date Distance
Wheeler Auto Funding (Project,
From To (Rs.)
Rickshaw/Taxi/O PDA or Insitute)
wn Vehicle)
Total (in words)___________________________________
Certified that no offical vehicle was made available for the purpose (s) specified above. I have actually
spent the amount (s) claimed above for the official purpose. The amount may be transferred to my
bank account.
(Signature of the Claimant)
(Signature of the Reporting Authority)
Date:
(For Use of F&A Division)
Checked and passed for payment of Rs…………………(Rupees……………………………………………..
……………………..). Total reimbursment during the year so far has been Rs……………………………….
(Assistant-Accounts) JM (Accounts)
Controller of Finance