H.P.T.R.

-7
TRAVELLI NG EXPENSES CLAI M FORM

1. Establishment :
Month.200
2. Name & Designation :
..
3. Basic Pay : .. Head Quarter


DEPARTURE ARRIVAL Km/
mode of
Journey
Rate/Class
of Travel
Actual
Fare
Paid
DAILY ALLOWANCE Total of
Line Station Date &
Hour
Station Date &
Hour
Hotel
Charges
(if any)
No.
of
days
Rate
Admis-
sible
Amount
1 2 3 4 5 6 7 8 9 10 11 12
























































Grand Total