(
उच्चत्तर शिऺा विभाग, मानि संसाधन विकास मंत्राऱय, भारत सरकार के तहत एक स्िायत्त संगठन) An autonomous organization under the
Department of Higher Education, Ministry of Human Resource Development, Government of India)
OUTSTATION TA CLAIM FORM To be filled by OUTSTATION TRAVELERS ONLY. *IT IS MANDATORY TO PROVIDE ALL DETAILS IN 1 ANNEXURE FOR UGC NET EXAM (20-30 Nov, 1-5 Dec 2021) 1 Name (strictly as per bank record)
2 Address for Communication
3 Registered Contact Nos)
4 PAN No.
5
CC’s full name (with contact no)
6 Outstation destination (From
– to)
7
Travelling dates 8 Bank Name and Branch
9 Bank Account No. (As per bank record in full digit)
10 IFSC code (As per bank record in full digit)
Amount Claimed (Details overleaf) My duty days were for UGC NET 2021. Table Expenditure Head Amount Receipt Serial number (A) Transportation (B) Hotel(Boarding) Expenses (C) Food Expenses Total Amount Certified that the particulars filled in above are correct and true. All the expenditure incurred money paid is in the interest of organisation.
………………………. …….……………………
(Signature & Seal of City Coordinator) (Signature and ID of Observer) Centre code …………………………………………………………………………………………………………………………………………………………….……. Share with your friends: 
