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Name, Rank & Unit of the Clai

 In lieu of I.A.F.T.1716
CLAIM FOR MOVE ON TEMPORARY DUTY (TOUR)

Name, Rank & Unit of the Claimant: _G.SRINIVASA SARMA,CLERK,A/c.No.8337342_______________________s

Headquarters/Office: O/oAAO GE(I)(P)(V)____________________Basic Pay___________________________________s

Orders for Move/Duty Authority (Rule in TR/SR) s

Station from where Journey commenced Date/Time of Start (a) s

Details of journeys by Road, Rail, Air, Steamer, etc. and D.A. for journey/Halt
Name of the place Arrival Distance Conveyance Departure No.of DA Rate Amount Remarks
arrived at Date Hrs by Road in Mode/Class Date Hrs. RMA/DA Rs. P.
Kms. (b) (c) (d)
(a) (a)

Cheque to be issued in favour of Self/Bankers viz. Total s

___________________________________ Amount of Advance s Received Payment

___________________________________ Balance due/Recovery due ______________

Revenue ___________________________________

Stamp ____________________________

Signature
 (a) Indicate Scheduled Train/Air/Bus timings. (b) When sharing public conveyance an indication may be made in Remarks Column. (c) CL or any other leave should be excluded
from the period of halt at outstation. (d) Indicate in Remarks column the number and date of Warrant Concession Voucher used for the journey
: 2 : -

Certified that:-

1. I performed road journey in (a) my own Car/own Scooter/Bus (b) sharing engaging full Taxi/Scooter/Auto Rickshaw _______________________________ (c) did not
use Govt. Transport for which road mileage allowance has been claimed.

2. I did not use Railway Warrant Concession Voucher for any portion of journey for which bills is preferred.

3. I was not provided with free boarding or lodging facilities.

4. I stay from _____________________ to _______________ at (Name of the Hotel) which provides boarding and lodging at scheduled tariff (Vouchers from the
hotel to be attached)

5. I was actually and not merely constructively present at the outstation on the days on which DA has been claimed and I did not proceed on CL or any other leave during
the period. I was on leave from _______________________ to ____________________.

6. I had not attended a previous similar course/examination.

Countersigned as correct claim

Station : ___________________________-

Date : _______________________
Signature and designation of the Officer countersigning the claim Signature of the Officer Travellin.
_________________________________________________________________________________________________________________________________

Passed for Payment ________________________________________________ on Treasury _______________________________________in favour of

___________________________________________.
Auditor Section Officer (A) Accounts Officer.