Bharat Sanchar Nigam Limited
( A Government of India Enterprise)
Admn. Branch
Annexure-A
REQUISTITION FOR SUPPLY OF GSM MOBILE HANDSET (IN DUPLICATE)
Name of the officer (in block letter)
Designation.
Staff No.
Employee No./HR Package No.
Scale of Pay.
Date of joining service in BSNL.
Details of last mobile handset supplied.
Date of last handset issued by BSNL.
Name of the unit which issued the handset.
Make and model No. of the handset.
Whether the handset has GPRS/MMS.
Date of superannuation.
UNDERTAKING.
Certified that.
I have been appointed/ promoted to present grade on regular/adhoc/local officiating basis and posted in Corporate office BSNL on (date) --------------------------------------------------as (designation) ---------------------------------on---------------------------------------vide order No.-
--------------------------------dated--------------------------(Copy of the posting /promotion order and copy of charge report are enclosed).
Neither any claim for cost of Mobile Handset has been preferred by me in any of the BSNL units nor a mobile handset has been issued to me by any of the BSNL units during the previous three years.
OR
It is certified that I have been allotted a GSM mobile handset of make ---------------------Model----------------on (date) ----------------------which is a non GPRS/MMS handset and hence I am preferring this claim before expiry of the three years period from the date of issue/claim of the last handset (Delete whichever is not applicable).
It is further certified that the information given in this Proforma is true and complete and nothing has been cancel.
Date:
Signature-----------------------------
Tele No.-------------------------
Date------------------------------ Place
Encl: As above.
ADMISSIBILITY CERTIFICATE:
(TO BE ISSUED BY ADMINSTRATION SECTION TO THE EXECUTIVES)
S.NO.8 cross-checked only in respect of handset issued by/claimed from BSNL Corporate Office eligibility has been decided based on undertaking by the individual in case of others. It is certified that:
Executives is eligible for supply of mobile handset costing up to Rs..--------------------(Rupees-----------------------------------------------------------------------). Purchase may be made from authorized dealer known brand in NCR, Delhi within one month of issue of this certificate and claim for reimbursement may be preferred, within 15 days of purchase.
D.M. (Admn.)
Certificate:
This is my first claim of Reimbursement for Mobile Hand-Set.
This claim of Reimbursement is after 3 years of purchase of previous Mobile Hand-Set.
The previous official Mobile Hand-Set provided to me is more than 3 years old.
Signature
Name-----------------------------------------
Designation----------------------------------
Bharat Sanchar Nigam Limited
( A Government of India Enterprise)
Admn. Branch
Annexure-B
CLAIM FOR REIMBURSEMENT OF COST OF MOBILE HANDSET.
(To be submitted by the officer after purchase of handset)
Particulars of mobile handset purchased (Brand, Model etc.)
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Name and address of the dealer from where purchased.
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Date of issue of Admissibility certificate.
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Date of purchase
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Actual amount paid (Rs.)
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Bill No. and Date
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CERTIFICATE:
Certificate that mobile handset mentioned in the claim was purchased for official use, within one month of issue of Admissibility certificate.
Certified that I have not submitted any other claim for the above purpose.
The bill/ voucher in original is enclosed.
Admissibility certificate is enclosed in original.
Encl: As above.
Signature of the claimant------------------------------------
Name-------------------------------------------------------
Designation ----------------------------------------------
Staff No---------------------------------------------------
Employee No--------------------------------------------
Tele No---------------------------------------------------
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