TOUR CLAIM LTC (PERSONAL)

Name S.Code Name of Contracts A) TRAVEL Departure

: : :

Duration: Places :

Arrival

Mode of Travel By individual

Amount Rs. By Company By Others

Date

Time

Place

Date

Time

Place

0.00

B) S.No.

LODGING EXPENSES Date Particulars

B TOTAL Amount

C) D.A@

C) Total:

D) Date

Local Conveyance Expenses Place From To By individual By Company By Others

D) Total: B/F E) Telephone, Tlx. etc. E) F) Other expenses (Pl. attach separate sheet) Total:

: Expenseds from A to F Advance taken / required : : Rs. Rs.

Balance due from / to company :

Rs.

Total tour expenditure

: Signature / Date: (Claimant)

Rs.

Sanctioned advance / total claim of Rs. Signature / Date