okIdksl e;kZfnr

WAPCOS LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)
5oka ry] dSyk'k] 26] dLrwjck xka/kh ekxZ] ubZ fnYyh & 110 001

vkdfLed vodk'k @ izfrcaf/kr vodk'k i=

APPLICATION FOR GRANT OF CASUAL LEAVE/RESTRICTED HOLIDAY

1. uke (Li"V vÕjksa es)a :

Name (in block letters) :

2. inuke :
Designation :

3. vuqHkkx :
Section :

4. visfÕr vodk'k dh vof/k :

Period of leave required :

5. vodk'k ysus dk vk/kkj :

Ground on which leave is required :

6. LVs'ku NksMuz s dh vuqefr :

(;fn vko';drk gks)
Permission to leave station :
(if required)

fnukad : vkosnd ds gLrkÕj

Dated : Signature of the applicant
________________________________________________________________________
vodk'k fjdkMZ
Leave Record
vkdfLed vodk'k ns; & 8 izfrcaf/kr vodk'k ns; & 2
Casual Leave Admissible – 8 Restricted holiday Admissible - 2

1. fy;k x;k……………………… 1. fy;k x;k …..…………………..….

Availed of Availed of

2. 'ks"k ……………….………….. 2. 'ks"k ……………….……………..…

Balance Balance

vodk'k dk fjdkMZ jÂus okys deZpkjh ds gLrkÕj

Signature of the official maintaining Leave Record

.i e x
vodk'k dh flQkfj'k djus okys ikzf/kdkjh dh fVIiÆh
Remarks of the authority recommending leave

uke ……………………………..…..
Name

inuke ……………………..……….
Designation

fnukad …………………………...….
Date
_____________________________________________________________________________

eatwjhnkrk izkf/kdkjh ds vkns'k

LohÑfr @ vLohÑfr
Orders of the Sanctioning Authority
Sanctioned/Not Sanctioned

uke ………………………….……
Name

inuke ……………………..….….
Designation

fnukad ……………………….…….
Date

fjdkMZ ds fy, visfz Ôr :

Forwarded for record to :

vuqHkkx dk vodk'k fjdkMZ

jÂus okys vf/kdkjh ds gLrkÕj
The officer nominated to control
Leave Record of the section
 okIdksl e;kZfnr
WAPCOS LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)
5oka ry] dSyk'k] 26] dLrwjck xka/kh ekxZ] ubZ fnYyh & 110 001

vfZt
Z rZ vodk'k@vodk'k uxnhdj.k@fpfdRlk vk/kkj ij vodk'k dh eatjw h gsrq vkosnu i=%
APPLICATION FOR EARNED LEAVE/ ENCASHMENT OF LEAVE/ LEAVE ON MEDICAL GROUND

1. vkosnd dk uke :
Name of Applicant :

2. inuke %
Designation :

3. LFkkbZ iSr`d fuokl dk irk %

Permanent Home Address :

4. izHkkx (;fn izfr fu;qfDr ij gksa rks d`Ik;k foHkkx dk mYys[k djsa
Division : (If on deputation, please indicate the department):

5. ewy osru %
Basic Pay :

6. visfÕr vodk'k dk izdkj rFkk vof/k

vkSj vodk'k ysus dh rkjh[k%
Nature and period of leave
application for and date from
which required :

7. vodk'k ysus dk vk/kkj%

Ground on which leave is required :

8. D;k vodk'k udnhdj.k pkfg,@

;fn gka rks NksMk x;k vodk'k%
Whether encashment of leave is
Desired. If so, the amount of
matching leave surrendered:

fVIi.kh % ;fn vodk'k fpfdRlk vk/kkj ij gS rks fpfdRlk izek.k i= lyaXu djsAa
Note : If leave is sought on medical grounds, medical certificate should be attached.

.i e x
D;k vodk'k ;k=k fj;k;r dk mi;ksx
djuk pkgrs gSAaS ;fn gka rks fuEufyf[kr lwpuk nsAa gka@ugha
Whether intends to LTC. Yes/No
If yes, please furnish the following information:

i) Cykd o"kZ % 2 o"kZ@ 4 o"kZ

Block year 2 Yrs. / 4 Yrs.
ii) LFkku tgka tkuk gSA %
Place of visit
iii) ifjokj dk C;kSjk Lo;a lfgr %
Details of family including self

Ukke lac/a k vk;q

Name Relationship Age

1. ………………………………………………………………………………………….…….
2. ……………………………………………………………………………………………….
3. ……………………………………………………………………………….………………
4. ……………………………………………………………………………………………….
5. ……………………………………………………………………………………………….

10. vodk'k@,y-Vh-lh- ds nkSjku irk%

Address while on leave/L.T.C.

fnukad % vkosnd ds gLrkÕj

Date : Signature of Applicant

vodk'k dh flQkfj'k djus okys vodk'k vkSj@;k vodk'k uxnhdj.k flQkfj'k dh tkrh gS@
izkf/kdkjh dh fVIi.kh Leave and/Or Encashment ugha dh tkrh gS
Remarks of the recommending Recommended/
Authority Not recommended

bl vodk'k ds nkSjku dke dh ns[kHkky djus dh O;oLFkk bl izdkj gksxh %

Arrangement to look after the work during this leave will be

Eaktwjhnkrk izkf/kdkjh ds vkns'k flQkfj'k izkf/kdkjh ds gLrkÕj

Orders of the Sanctioning Authority Signature of the Recommending Authority
 Form No. WAP/ADMN/5

ty ,ao fo|qr ijke'khZ lsok,a

k,a (Hkkjr
Hkkjr)
Hkkjr e;kZfnr
WATER AND POWER CONSULTANCY SERVICES (INDIA) LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)

dk;kZjEHk izfrosru
JOINING REPORT

eSa ,rn`}kjk, vkt fnukad------------------------------------------------------------------iwokZg@z vijkgz dks fnukad --------------------------------

------- ls ------------------------------------ rd jfookjks@a vodk'kksa ds ukrs ------------ dks igys o ------------------------ dks ckn esa tksMus dh

vuqefr ds lkFk Lohd`r ------------------------------fnuksa ds vftZr vodk'k@ifj.kr vodk'k@v/kZors u vodk'k, fpfdRlk izek.k i= vk/kkj

fpfdRlk izek.k i= ds fcuk ls okil vkus ij viuk dk;kZjEHk izfrosru izLrqrq djrk@djrh gWAaw

I, hereby submit my joining report today the ……………………………..…….………… F.N./A.N. on return from

…………………………………………..days Earned Leave/Commuted Leave/Half Pay Leave sanctioned to me on

Medical Certificate/Without Medical Certificate with effect from .……………………..………….. to

…………………………………………. with permission to perfix ……………… and suffix …………………….

being sundays/holidays.

Izkkf?kd`r fpfdRlk ifjpj dk vkjksX; izek.k i= lyaXu gSAa

A certificate of Medical Fitness from Authorised Medical attendant is enclosed.

gLrkÕj …………….……………………...…
Signature

uke …………….……………………..………
Name

fnukad : inuke ………………………….……………..

Date : Designation
 ty ,ao fo|qr ijke'khZ lsok,a,a (Hkkjr
Hkkjr)
Hkkjr e;kZfnr
Hkkjr ljdkj dk miØze)
(Hkkjr
76&lh] lSDS Vj&18] xqM+xkao (gfj;k.kk)
gfj;k.kk)

ioZ is'kxh gsrq vkosnu i=

1. uke o inuke %

2- ewy osru ,oa osrueku %

3 osru dksM la[;k(RRW) :

4- fu;qfDr dk izdkj % fu;fer@izfrfu;qfDr@MsiVw 's ku

5- fiNys volj ij yh xbZ %

is'kxh ioZ dk uke vkSj frfFk

6- ioZ@volj dk uke ftlds %

fy, is'kxh pkfg, rFkk
fnukad

7- LdU/k@vuqHkkx %
(izfrfu;qfDr ij vk;s deZpkfj;ksa ds fy,)

8- iSr`d foHkkx ,oa iwjk irk %

9- okIdksl esa dk;Zxgz .k dh frfFk%

vuq'kalk djus okyk vf/kdkjh izkFkhZ ds gLrk{kj _ _ _ _ _ _ _ _ _ _

(uke o inuke) fnukad lfgr
fnukad _ _ _ _ _ _ _ _ _

izsf"kr%
lgk;d izc/a kd (dk-
(dk-)

ys[kk foHkkx ds lgk;d izc/a kd ys[kk&2 dks vxzfs "krA d`Ik;k izkFkhZ ij ioZ is'kxh 'ks"k ugha gS rFkk foRr o"kZ esa vkosnu
izFke ckj fd;k gS dk lR;kiu djsa vkSj rqjUr ykSVk,aA

lgk;d izc/a kd (dk-

(dk-) lgk;d izc/a kd (ys[kk&2)
 WAPCOS EMPLOYEES COOPERATIVE THRIFT & CREDIT SOCIETY LIMITED
‘KAILASH’ 5TH FLOOR, 26, K.G. MARG, NEW DELHI-110 001

APPLICATION FOR LOAN

I here apply for an advance from the WAPCOS Employees Co-operative Thrift & Credit Society Limited
particulars for which are given below:-

1. Name of Member _______________________ RRW NO. ________ BANK A/C NO.____

2. Designation _______________________________________________________
3. Unit / Office _______________________________________________________
4. No. of share held _______________________________________________________
5. Nature of advance required :
(i) Emergency Loan Rs. _________________________________________________
(ii) Regular Loan Rs. _________________________________________________
6. Purpose for which required _________________________________________________
7. Number of installments proposed for ____________________________________________
8. Particulars for previous advances :-
(i) Amount Rs. _________________________________________________
(ii) Month of payment of last installment ____________________________________
9. Present Basic Pay Rs. _________________________________________________
10. How payment desired ?
(i) Crossed cheque
(ii) Uncrossed cheque

PLACE : NEW DELHI

DATED : SIGNATURE

To,
The Secretary,
WAPCOS Employees Co-operative Thrift
& Credit Society Ltd., New Delhi

Sanctioned in the Managing Committee Meeting held on __________________________

PAID VIDE CHEQUE NO. _____________________

DATED _______________ FOR RS. _______________ SIGNATURE
 QkeZ la0 oSi@ys[kk@07
GOTM NO. ESP/SV./07

ty ,ao fo|qr ijke'khZ lsok,a (Hkkjr

Hkkjr)
Hkkjr e;kZfnr
WATER AND POWER CONSULTANCY SERVICES (INDIA) LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)

;k=k HkRrk fCky @ TRAVELLING ALLOWANCE BILL

uke@ Name ………………………………..…………… inuke@Designation …………………..…….…..

mns'; (la{saki esa )/ Purpose in brief ifj;kstuk@vlkbUesaV dk uke
ewy osru@ Basic pay : Rs. ……….…………………… Name of Project/Assignment/Project Code

I. ;k=k dk;Zdze @ ITINERARY

izLFkku@Departure vkxeuArrival VIi.kh];fn dksbZ gks
ls@From fnukad@Date le;@Time rd@At fnukad@Date le;@Time Remarks if any

II. nkos dh jkf'k / AMOUNT CLAIMED

I. gokbZ@jsy@cl fdjk;k@Air/Rail/Bus fare

ls@From rd@To okgu@Mode Js.kh@Class fVdV ua0@Ticket No. fdjk;k@Fare Charges

II. lMd dk ehyHkRrk (lkekU; ;k0Hkk0 fu;eksa ds vuqlkj)/Road Mileage (Under normal TA Rules)

fojke dh vof/k dk nSfud HkRrk (;k=k dk;Zdze ds vuqlkj) foHkkftr nj

3. Daily/Allowance for halts (as per itinerary) Split Rate

fojke dk LFkku fnuksa dh la[;k dqy nSfud HkRrk vkokl O;; nSfud HkRrk ;ksx
Place of halt No. of days Composite daily Lodging Daily Total
Allowance Charges Allowance

UkskV & foHkkftr njksa ds varxZr vkokl O;;- jlhn izLrqr djus ij gh Lohdk;Z gksxkA
Note : Lodging charges under split rate are admissible only on production of receipt.

fiNyk tksM-
Total B/F
OkkLrfod ;k=k O;; (fooj.k nsa)
4. Actual travel expenses (Exp. On Tel/Telex & entertainment etc. ie other then TA to be claimed

.i e x
 separately)
(d)
(a) ……………………………………………….
([k)
(b) ………………………………………………
(x)
(c) ………………………………………………
(?k)
(d) ……………………………………………….
(M-)
(e) ………………………………………………..

dqy nkok
Total Claim ……………..
fy;k x;k vfxze ?kVk,a
Less Advance drawn Rs. …………………………
ysus dh rkjh[k
Date on which advance drawn …………………..
ukfer O;fDr dk uke vkSj irk
III. Name of the Nominee and address ………………………………………………………………
ns; fuoy jkf'k
Net amount payable /Recoverable Rs. ……………………………..
izek.k i=
Certificate
izekf.kr fd;k tkrk gS fd i) fcy esa fn, x, vkWdMs- lgh gSsA
IV. Certificate that The date and time given in this bill are correct.
ii) bl fcy esa fn[kkbZ xbZ vof/k ds fy, ;k-Hkk-@nS-e- dk u rks L=ksr ls nkok fd;k
x;k gS vkSj u gh blls igys bl [kkrs ls nkok fd;k x;k gSA
TA/DA for period covered in this bill has neither been claimed from any other
sources nor I have made any claim previously on this account.
iii) dEiuh@xzkgd }kjk fu%'kqYd Hkkstu@vkokl miyC/k djk;k x;k@ugha djk;k
x;kA
Free boarding/Lodging was not provided/provided by the Company/Clients.
iv) eq>s nh xbZ fons'kh eqnzk iw.kZ :Ik ls mi;ksx dj yh xbZ gS vFkok iz;ksax ugha
dh xbZ fons'kh eqnzk okIdksl ds ek/;e ls okil dj nh xbZ gSA
(Signature of the officer) The entire foreign exchange, if any, Issued to me has been utilised or the unutilise
foreign exchange has been surrendered by me through WAPCOS.

nkosnkj ds rkjh[k lfgr gLrk{kj

Date signature of the claiment
vuqeksfnr
Approved for Rs. ……………………………………………………………….
………………………………………………………………
………………………………………………………………

lg-iz-@mi-iz-@iz-(foRr)@ o-iz-(foRr) fu;a=.k vf/kdkjh

Asstt. Mgr./Dy. Mgr./Mgr.(Fin)/Sr. Mgr. (Fin) Controlling Officer
 ty ,ao fo|qr ijke'khZ lsok,a (Hkkjr
Hkkjr)
Hkkjr e;kZfnr
WATER AND POWER CONSULTANCY SERVICES (INDIA) LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)

izfriwfrZ@lek;kstu okmpj fnukad

Reimbursement/Adjustment Voucher Date _______________

jkf'k fdl fy, O;;@vnk dh xbZ #Ik;s

To amount paid / spent for Amount

?kVk,a- fy;k x;k vfxze #Ik;s

Less, Advance taken on Rs.
fufoy olwyh- ns; #Ik;s
Net Recoverable, Payable (+) (-) Rs.

LkR;kfir % nkosnkj ds gLrk{kj

Varified : __________________________________ Claimant’s Signature_______________________

Ukke
Name ________________________________ uke _________________________________
Name ___________________________________

______________________ #0 ds fy;s vuqeksfnr inuke

Approved for Rs. _________________________ Designation ______________________________

fo0 l0@ eq0v0@ eq0iz0(dk- o iz0)@ eq0 iz0(foRr)

FA/CE/Chief Manager (P&A)/Chief Manager (Finance)

v0 ,oa iz0 fu0@ e0 iz0

CMD/ GM

.i e x
 okIdksl e;kZfnr
WAPCOS LIMITED
Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)

fpfdRlk [kpsZ dh izfriwfrZ Z ds vkosnu&Ik= ifj0 dksM la-@

APPICATION FOR REIMBURSEMENT OF MEDICAL EXPENSES Proj. Code No.
Eqk[;ky;/ H.O.

deZpkjh dk uke o inuke ewy osru

1. Name of the Employee & Designation _________________________________________ Basic Pay ______________
jksxh dk uke o deZpkjh ls lECkU/k
2. Name of the Patient and Relationship with the Employee__________________________________________________
?kj dk irk
3. Residential Address ______________________________________________________________________________
MkDVj dk uke] ;ksfxrk ,oa iathdj.k la- bykt dh vof/k
4. Name, Qualification & Registration No. of the Doctor _______________________Period of Treatment ___________
IzfriwfrZ dk C;kSjk nkos dh jkf'k Lohdk;Z jkf'k izfriwfrZ dk O;kSjk nkos dh jkf'k Lohdk;Z jkf'k
5. Particulars of Amt. Amt. Particulars of Amt. Amt.
Reimbursement Claimed Admissible Reimbursement Claimed Admissible
Ikjke'kZ 'kqYd nokb;ksa dh dher
i) Consultation Fee ___________________________ iv) Cost of medicine ___________________________
bUtsD'ku pktZ jksxkRed O;;
ii) Injection charges___________________________ v) Pathological charges________________________
vU; O;; dqy
iii) Other charges______________________________ vi) Total ____________________________________

eSa izekf.kr djrk gwW fd mij fn;k x;k fooj.k Bhd gS vkSj [kpZ okLro esa fpfdRlk ds fy, fd;k x;k rFkk ftu O;fDr;ksa ds fpfdRlk
[kpZ fd;k x;k os iw.kZr% eq> ij vkfJr gSAa lkFk gh izekf.kr djrk gwW fd bl jkf'k dk dgha vU;= nkok ugha fd;k x;k gSA
I certified that the particulars given above are correct and the expenditure has actually been incurred for medical treatment
and the person(s) for whom medical expenses have been claimed is/are wholly dependent upon me. Certified that the amount
has not been claimed from any other source.

fnukWd deZpkjh ds gLrk{kj

Dated Employee’s Signature
dsoy dk;kZy; ds iz;ksx ds fy,
FOR OFFICE USE ONLY

tkap fd;k@lR;kfir fd;k vkSj vuqeksfnr #Ik;s ds fy,

Checked/verified and approved for Rs. __________________________________________________________

lgk;d l-iz-@mi-iz-(foRr)@iz-(foRr) eq[; izcU/kd-(foRr)@fo-l- v-,oa iz-fu-

Assistant Asstt. Mgr./Dy. Mgr.(Fin)/ Mgr. (Fin) Chief Manager (Fin.)/F.A. C.M.D.
 ty ,ao fo|qr ijke'khZ lsok,a (Hkkjr
Hkkjr)
Hkkjr e;kZfnr
WATER AND POWER CONSULTANCY SERVICES (INDIA) LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)

AUTHORITY

Received from M/s. Water and Power Consultancy Services (India) Limited, a sum of

Rs. ________________________ (Rupees ________________________________________

_____________________) towards _____________________________________________

______________________________________.

(NAME & DESIGNATION)

I authorized Shri/Smt. ___________________________________________________ to

receive the said payment on my behalf under due acquaintance.

(NAME & DESIGNATION)

.i e x
 okIdksl e;kZfnr
WAPCOS LIMITED
(Hkkjr ljdkj dk miØze)
(A GOVERNMENT OF INDIA UNDERTAKING)
5oka ry] dSyk'k] 26] dLrwjck xka/kh ekxZ] ubZ fnYyh & 110 001

REQUISITION SLIP FOR HIRING OF VEHICLE

1. Name & Designation of the Officer :

who proposes to use the vehicle/project
to which Guest relates for Name of the
Company’s Guest

2. Date & time when Vehicle is required :

3. Details of Places/Office(s) to be visited :

4. Place where vehicle is required :

5. Chargeable Head :

SIGNATURE

DIVISION

The requirement of vehicle is necessary keeping in view of work requirement. It is certified that
the unit’s vehicle is not available has already been sent on same other assignment.

Sufficient Provision exists under the head for this purpose.

Approved / Recommended.

SIGNATURE OF HOD
Approved / not approved.

GENERAL MANAGER

Manager (Admn.)/ Controlling Officer

The vehicle hired from M/s. …………………………………………………………..

At …………………………………… and the same reported to concerned officer.

SIGNATURE
TO
MANAGER (ADMN.)

.i e x
 ty ,ao fo|qr ijke'khZ lsok,a (Hkkjr
Hkkjr)
Hkkjr e;kZfnr
WATER AND POWER CONSULTANCY SERVICES (INDIA) LIMITED
Hkkjr ljdkj dk miØze)
(Hkkjr
(A GOVERNMENT OF INDIA UNDERTAKING)

deZpkjh dk uke o inuke lanHkZ% ifj;kstuk@eq[;ky;

Name & Designation of the Employee ________________________________ Ref.: Project / H. Qrs.

le;ksifj HkRrs dk nkok

CLAIM FOR OVER-TIME ALLOWANCE

,d ?kaVk dVkSrh ds
ckn pktZ fd;k x;k le;
vkSj deZpkjh }kjk
vof/k dk;Zky; esa nsj rd
dk;Z fnol vFkok NqVVh
Period Dk;Z dk mifLFkr jgus dk le; ;k nkos dh
dk fnu
fnukad okLrfod le; tSlk gks nj jkf'k
Date Actual time Time charged after Rate Amount
Whether working day or
charged deducting 1 Hr. & the claimed
Holiday
time by which the
ls rd
official attended
From To
office late or such as
the case may be

eSa izekf.kr djrk gwS fd izR;sd rkjh[k ds vkxs nh xbZ vof/k esa dk;kZy; le; ds ckn 'kfuokj@jfookj@vodk'k esa
dk;kZy; ds dke ls M;wVh ij jgkA vof/k ds nkSjku esjk osru ,oa HkRrs bl izdkj gS %&
Certified that I was on duty for the period mentioned against each date above after office hours/on Sunday/holidays for
official work. My Pay and allowance during the period are as under :-

.i e x
 Oksru #- e-Hk-#-
Pay Rs. ______________________________________ D.A. Rs.__________________________________________

Ukxj Hk-#- dqy #-

C.C.A., Rs. ___________________________________ Total Rs. _________________________________________

deZpkjh ds gLrk{kj
Signature of the official______________________________

Iwkjk uke
Full Name (In Block Letters)_________________________

in
Designation ______________________________________

eSa izekf.kr djrk gWw fd deZpkjh ftlds ekeys esa le;ksifj HkRrs dk bl fcy esa nkok fd;k x;k gS mldh fo'ks"k vkns'kksa
ds vk/khu mijksDr rkjh[kksa esa mifLFkr gksus] iwjs fnu dk dke djus ds ckn nsj rd dk;kZy; esa cSBus dh ,sls vko';d dk;Z ls
ftls dEiuh ds fgr esa vxys dk;Z fnol rd jksdk ugha tk ldrk Fkk] vko';drk FkhA
Certified that the official in whose case the overtime allowance has been claimed in this bill was/were required under
specific orders to attend office/sit late in office after having put in full day’s work on the dates mentioned above for disposal
of urgent work which in the Company’s interest could not be postponed the next working day.

;g Hkh izekf.kr fd;k tkrk gS fd fcy esa nkok dh xbZ jkf'k foRr ea=ky; ds le;≤ ij la'kksf/kr dk;kZy; Kkiu la-
15011@2@bZ- 11(ch)@76 fnukad 11 vxLr] 1976 ds }kjk fu/kkZfjr njksa ds vuqlkj gSaA
Also certified that the amount claimed in bill is in accordance with the rates prescribed in the Ministry of Finance Office
Memo No. 15011/2/E 11(B)/76, dated the 11th Aug. 76 as amended from time to time.

;g Hkh izekf.kr fd;k tkrk gS fd deZpkjh }kjk bl le;ksifj dk;Z ds fy, dksbZ vU; ikfjJfed@okgu@O;;@ iwjd vodk'k ugha
fy;k x;kA
Also certified that the staff did not receive any other remuneration/conveyance charges/compensatory leave for the
performance of the over time work.

vklUu vf/kdkjh ds gLrk{kj

Signature of the Immediate officer
 ty ,ao fo|qr ijke'khZ lsok,a,a (Hkkjr
Hkkjr)
Hkkjr e;kZfnr
Hkkjr ljdkj dk miØze)
(Hkkjr

vodk'k ;k=k fj;k;r uxnhdj.k ds fy, okIdksl ifji= la0 oki@ys[kk@95 fnukad 21-2-95 ekU;
Js.kh ds jsy fdjk;k dk 4 O;Ldks ds fy, 1500 fd-eh- (,d rjQk) 75 izfr'kr rd dh jkf'k dk fdjk;k
uxnhdj.k pkyw 4 o"kksaZ ds Cykd o"kZ ls izHkkoh gksxkA

uke %

inuke %

LFkkbZ fuokl LFkku %

izHkkx %

ewy osru %

fiNyk vodk'k ;k=k % 2002&2005 Cykd o"kZ (pkyw)

fj;k;r 2006&2009

ifjokj dk O;kSjk (Lo;a lfgr) %

dz-la- uke laca/k vk;q

1-
2-
3-
4-

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 Annexure

CLAIM-CUM-VERIFICATION FORM

1. Vide WAPCOS office order No. _____________________ dated __________________

worked for ______________________(days/months) from ______________________
to _________________ on ____________________ attached to __________________
Division in Technical Unit _________________.

2. I am/am not in receipt of medical facility from any other source.

3. I am using staff Car/my own car/scooter for official work.

4. I am entitled to Rs. _________________ for the services rendered by me and

reimbursement of Rs. _______________________ for Trunk calls charges made for
official purpose. Receipt for payment of Trunk calls charges is enclosed.

5. The amount of Rs. ____________________________________ may please be paid

(Reimbursement & T.C. charges)
and remitted tome at the following address through cheque/ DD payable
___________ ________.

Address ______________________________

______________________________

______________________________

______________________________
(Name & Division of Consultant/
Development Advisor)
(In Block letters)

Date :

Cont’d……….
 VERIFICATION

1. The claim of Shri _______________________________ consultant (TLE/SLE/MLE/JLE/

Development Adviser for __________________________________ (days/months)
from____________ to _____________ is verified.

2. It is certified that the work assigned to him has been completed satisfactorily and payment
of Rs. _______________ in terms of above office order is recommended for release. He
has submitted a handing over note and submitted all documents, data, computer programs,
design calculations etc. and the same has been duly received.

3. The expenditure is chargeable to:

Project Code No. __________________

Name of the Project __________________

4. Payment of Rs. __________________ on account of official trunk calls as supported by

receipt, is authorized to Shri ________________________

5. Finance may please arrange payment of Rs. _____________________________________

(reimbursement & other payment)
to Shri__________________________________ (Consultant/Development Adviser)

6. Find enclosed is the monthly utilization statement.

Sr. Engineer/ ACE

Chief Engineer

General Manager (Power)

General Manager (F)

 WAPCOS LIMITED
GURGAON

Sub: Submission of saving details and House rent receipts – regarding

Please find enclosed herewith saving details and House rent receipts of
undersigned for your perusal. Taxes may be calculated accordingly for this current
financial year (2011-2012).

Encl:

Parveen Ansal
(Engineer)
RRW 773