INDIAN INSTITUTE OF TECHNOLOGY : DELHI
 HAUZ KHAS : NEW DELHI

1. Name     :

2. Pay      :

3. Station from where
 journey concerned   :

4. Fare paid for both ways
 and mode of conveyance  :

5. Date & Time when the
 journey was made from
 the Head Quarters   :

6. Local Journey by Road
 at the Head Quarters  :

7. Arrival Date/Time at
 Delhi/IIT              :

8. Date and time of
 leaving IIT Delhi   :

9. Date of time of
 reaching Head Quarters :

10. Local journey at
 Delhi (by road)  :

11. Purpose of visit   :

12. Whether free boarding
 and lodging availed
 at IIT Delhi    :
 

13. Any other information  :
 
 

 Signature Officer

Certified that :
 

1. I travelled by the class of accomodation for which T.A. has been claimed.

2. I was actually and not merely constructively present in the campus for the days for which D.A. has been claimed.

3. I was not provided with free boarding lodging at the expenses of Government, of State of any organization financed from state funds during the days for which full daily allowance has been claimed.

4. I also did not stay during tour in Circuit House/Inspect Bunglow/Rest. House etc., without paying any charge for accommodation.

5. I was not provided with any means of Conveyance at Government expenses.

6. I did not perform the real journey for which mileage allowance has been claimed at the higher rates prescribed rules 48 of D.R.'s by taking a single seat in any public conveyance excluding steamer which regularly plies for between fixed point and charges fixed rates.  I also certify that the journey was not performed in any other vehicle without payment of its hire charges incurring its running expenses.

7. I did not avail of any casual leave during the period for which T.A. has been claimed.

8. Certified that no return ticket were available for this journey.

9. I actually performed the journey by Mail Express trains for which fare has been claimed.

10. The road mileage claimed in the bill is correct to the best of my knowledge and belief.

11. I have not claimed and will not claim the travelling allowance for the journey for which the claim pertains from any other source.
 
 

 Signature_________________

 Name___________________

 Designation_______________