V.
No_______
Hkkjrh; [kfu fo|kihB] /kuckn Date________
INDIAN SCHOOL OF MINES, DHANBAD
TRAVELLING ALLOWANCE BILL /CLAIM FORM
(ISM-JRF/ M.TECH/ M.PHIL/ 5 YRS DD/ 5 YRS MSC/MSC TECH/ B.TECH)
PART – A (To be filled in by Student)
1. Name 2. Admission No.
3. Department
3. Purpose of Journey 4. Expenditure Head
5. Contact No (Mobile)
6. Details of journey(s) performed:
Departure Arrival Mode of journey Fare paid in Distance in Ticket Duration of
and class of Rupees KM No. Halt
Date & From Date & To accommodation
Time Time
1 2 3 4 5 6 7 8 9
8. Dates of absence from place of halt on account of :
a) RH and CL _________________
b) Not being actually in camp on Sundays and Holidays ________________
9. Date on which free board and /or lodging provided by any organization financed by state funds:
Board only/Lodging only/Boarding and lodging ________________________________________
10. Amount of TA/DA drawn from other organization, if any (please give details)________________________________
11. Particulars to be furnished along-with hotel / guest house receipts etc. , for stay in Hotel/ Guest House / other establishments providing
board and / or lodging at scheduled tariffs (please attach hotel bills):
Period of Stay (Date and time) Name of the Hostel / Guest Bill No and Daily rate of Total amount
From To House (whether Govt. or Date lodging charges paid (Rs.)
Private) (Rs.)
12. Amount of TA advance drawn, if any Rs _____________________ Date of drawal ________
Signature_____________________
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13. CLAIM OF LOCAL CONVEYANCE CHARGES ON TOUR FOR OFFICIAL PURPOSES AT
(CITY)__________ from (Date)________ to ___________
FROM TO Mode of No of Rate Amount Purpose/
Date Time Office/Place Date Time Office/ Transport Kms. Paid Work done
Place
14. Details of daily expenses on food (Please attach supporting bills for reimbursement)
S No Date Purpose Cash Memo/ Bill Amount
No
Signature_____________________
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15. Other Expenses in respect of Foreign Tour :-
1 Local Conveyance Charges
2 Registration Fee
3 Other expenses, if any, please mention
Certified that above expenses is actual and paid by me in connection with food expenses during tour.
Date ____________ Name: __________________________________
1 Tour approval Bank details :-
2 Tour Diary Bank Name :
3 Food bill IFSC Code :
4 Hotel Bill Bank A/c No. :
Certificate in respect of Official Journey
Period from (date) ___________ to (date)____________
(i) Certified that the mileage claimed in the TA bill is correct to the best of my knowledge.
(ii) Certified that I did not perform the road journeys for which mileage allowance has been claimed at the
higher rate prescribed in rule 48 of supplementary Rule by taking a single seat in any public ) fixed
rates. Also certify that the journey was not performed in any other vehicle without paying its hire
charges or incurring running charges.
(iii) Certified that journey was performed by the shortest and cheapest route of the entitled class and fares
claimed were actually paid by me to the Railway/ Air/ Transport authorities
(iv) Certified that no such travelling allowance bill for the period mentioned above has been claimed from
any other source.
(v) Certified that I did not avail myself of any casual leave/RH for the days for which Daily Allowance
(food/ hotel bills) are claimed.
(vi) Certified that I did not avail of free boarding and / or lodging at the expense of State Govt or any
organization financed from state funds during the days for which food expenditure has been claimed.
(vii) Certified that I travelled by air to which I am entitled and air tickets were purchased on cheapest fare
of the entitled class and mileage earned on the tickets will be used for the official purposes only.
(viii) Certified that the information as given above is true and correct to the best of my knowledge and
belief.
Date: Signature of Claimant ______________
Signature of HOD _________________________
Signature_____________________
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Part-B (For the use of Accounts Section)
(Rupees)
1. Rail fare
Air fare
Road fare
2. Road mileage (as per column 13 for Kms. @ Rs. per km)
3. Accommodation/ Hotel Charges (as per column 11)
4. Daily Allowance (Reimbursement of food bills as per column 14):
Foreign DA
Domestic DA:-
1. Days @ Rs per day Rs.
2. Days @ Rs per day Rs.
3. Days @ Rs per day Rs.
5. Other Expenses :
Local Conveyance Charges
Registration Fee
Other expenses, if any, please mention
6. Gross amount (Rupees )
7. Less amount of TA Advance drawn if any
8. Net amount Payable / Recoverable
(Rupees :- )
The above expenses is debitable to:-
Dealing Assistant Junior Superintendent (A/C) Section Officer (I/A) Asstt. Registrar (I/A)
Asstt. Registrar (A/C) / Dy Registrar (F&A) Dean (Academic)
Received Rs. vide cash / cheque No. dated
Signature
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