Pttyda
Pttyda
Pttyda
- 1715
Rule in TR / SR..
No and date of letter. Pt. II orders, POR etc authorizing the move..
Time
Date
and
Place
Departure .
Arrival
...
Total No.
To
Rly Station
Rly Station
Rly Station
Rly Station
Residence
Mode of
Conveyance
Class
Distance
Rs.
P.
Daily
For Adults
Allowance
For Minors
Personal Effects
Luggage
Weight
Luggage
Conveyance
Cartage-Residence to Booking Office
Booking Office to residence
Transfer Grant
Advance received from....inTotal
Received payment Rs...P(Rupees)
Signature of the Claimant
Revenue Stamp
Cheque to be drawn on
*Actual time of departure and arrival and dated from Rly Station, Air Port etc. should be shown
**Details of members of family wholly dependent on Govt Servant for whom the claim is referred should
be shown. (If claims are preferred separately, reference to earlier claim should be given)
2
I certify, that (i) the journeys set out on the reverse have actually been performed by the mode and class
indicated against the relevant columns and distances stated in the claim are correct.
(ii) I certify that my legitimate child/children/step child/children/parent(s)/Unmarried Sister(s)/Minor
brother(s) for whom fares etc. have been claimed reside(s) with me and is/are wholly dependent on me
and that his/her/their individual income from all sources including pension (inclusive of temporary
increase in pension and pension equivalent of death-cum-Retirement gratuity) does not exceed Rs. 250/P.M.
(iii) I certify that no Govt. transport was provided for the journeys for which mileage and/or cartage have
been claimed and that no Warrants, concession vouchers have been used by me/my family for which a
claim has been preferred.
(Note :- Score out certificates/portions not applicable)
Station..
Date..
(Signature of the Claimant)..
Countersigned as correct claim
Classification
Passed for Rs..Rupees
Receipts
Auditor
Charges...
Debt.
Vr Nofor.
Paid Rs..
In favour of.
.onTreasury
onon..Treasury
SO(A)
AO/ACDA
Auditor
SO(A)
AO/ACDA
INSTRUCTIONS
1.
2.
3.
4.
5.
Copies of sanctions (except secret or confidential) should be attached with the claim.
Sanction of competent authority where necessary should be attached.
Claim should be countersigned by the Controlling Officer at New Duty Station.
When journey is on Warrant, etc. full particulars should be given.
Receipt Vouchers in support of payment made for transporting luggage and other conveyance
should be submitted with the claim.
6. The claim in adjustment of advance taken for the move should be submitted immediately after
completion of journey.