Metallurgical and Materials Engineering Department
Indian Institute of Technology Roorkee
Traveling Allowance Bill
Name:
Designation:
Address:
Particulars of Journey
Departure
Station
Date
1
2
Time
3
Station
4
Arrival
Date
5
Mode of
Journey
Time
6
7
Journey by Rail/Road/Air
Class
Fare
Rs.
8
9
Incidental
Distance Rate Amount
10
11
12
Pay: …………DA……..……….
Total Rs ………………………….
Local Journey
To
Distance
in km
14
15
From
13
Amount
16
17. Number of days
for which DA is
claimed:
Rate of DA
Total Amount of DA:
18. Purpose of journey
with date:
19. Remarks
Total
1.
I certify that I have not drawn TA or DA in this connection from any other source. The payment is
actually due and is being charged for the first time.
1.
2.
I certify that I have actually traveled in the class for which I am charging Railway / Air fare as paid
by me.
3.
I certify that I did not avail of free boarding and lodging facilities at the outstation.
4.
Onward journey will be performed as claimed
Total
Sum of totals in columns
9, 12, 16 and 17, AND 19
Rs …………..…….
2.
Advance, if any
Rs………………….…
3.
Net Claim
Rs…………………….
Total =
For Office Use only
Pay Rs.
Rs.
Debit to ………………………………….
COUNTERSIGNED
Signature of the Claimant
Signature of the Claimant
Claim Verified
………………………………….
Verifying Officer
Controlling Officer
O.S. (Bills)
AAO
FC