Note: This bill should be prepared in duplicate / one for payment and the other for record as office copy
Part A (to be filled up by the Claimant)
- Details and purpose of journey performed:
|Departure||Arrival||Mode of Travel and Class of Accommodation||Fair Paid||Distance in Kms. for Road Mileage||Duration of Halts||Purpose of Journey|
|Date & Time||From||Date & Time||To||Rs.||Ps.||Days||Hrs|
Mode of journey
If a higher rate of Daily Allowance is being claimed for stay in hotel or other establishments proving board and/or lodging at scheduled tariffs, furnish the following particulars, supported by hotel bills/receipts etc.
|Period of Stay||Name of Head||Daily Rate of Lodging Charged||Total Amount Paid|
Particulars of journey(s) for which a class of accommodation higher than the one to which the employee is entitled was used:
|Date||Date||Name of Places||Mode of Conveyance Used||Class to which entitled||Class in which traveled||Fare of the entitled class|
If the journey/s by the higher class has been performed with the approval of the competent authority, quote Number and date of the sanction.
Details of journeys performed by road between places connected by rail
|Date||Date||Names of Places||Fare paid Rs.|
Amount of TA advance, if any, drawn.
I am drawing / not drawing transportation allowance @ Rs _______ per month.
Certified that the information as given above, is true to the best of my knowledge and below.
Signature of the Employee
- Air : Exchange voucher arranged by office
Ticket / Exchange voucher arranged by
- Rail : Whether traveled by Mail/Express/Ordinary train?
Whether return ticket available?
If available, whether return ticket purchased? If not, state reasons.
- Road : Mode of conveyance used, i.e, by Govt. transport / by taking a taxi, single seat in a bus or other public conveyance / by sharing with another employee in car belonging to him or to a third person is to be stated.
- Date of absence from place of halt on account of –
- Restricted holidays and Casual leave taken, if any.
- Day(s) on which the claimant was not actually in camp on Sunday and holidays.
- Dates on which free board and / or lodging was provided by the state or any organization financed by state funds –
- Board only
- Lodging only
- Board and lodging