TRAVEL ALLOWANCE FORM

HINDUSTAN PETROLEUM CORPORATION LIMITED

Officer Trainee and Information Systems Officer Recruitment
REIMBURSEMENT FOR TRAVEL EXPENSES TOWARDS APPEARING FOR WRITTEN TEST ON 12th August 2012 (For Scheduled Caste / Scheduled Tribe / Persons with Disability candidates) Name & Mailing Address:

Roll No. : .. Application Number .... Category: (Put ' SC / ST / PWD

'mark

as applicable)

Position
Pin Code: . Contact Tel. No: ...
JOURNEY DETAILS:
Journey Date(s) Mode of Travel Class of Travel Ticket / Receipt No. Travel Fare (Rupees)

Venue . Centre/City...

From. . To.

Rail / Bus

From. . To ... Rail / Bus TOTAL RUPEES =

a) Attach Original / Photocopy of Rail / Bus Tickets / Receipt towards proof of jour ney. b) Attach copy of Caste / PWD Certificate (as applicable).

DECLARATION:

1. I will not claim the amount from the Government or my present employer. 2. I hereby affirm that the information furnished by me in this form is true and any false information will render me liable for non-payment of travel expenses. Please issue DD in favour of.. ................................................................................................................ . towards the above. The same may be sent to mailing address as mentioned above.

Venue: Date: Signature of Candidate

Reimbursement of Travel Expenses will be made for 2nd class rail / bus fare by the shortest route to the examination centre for outstation SC, ST & PWD candidates, provided the distance traveled is not less than 30 kms. (Candidates opting for examination centre other than the centre nearest from mailing address will not be reimbursed). Payment will be made to SC, ST & PWD candidates through DD(to be sent through Post) subject to submission of TA (Travel Allowance) Claim form along with original Ticket/Receipt or Photocopy there of or original bus ticket/s and copy of caste/disability certificate after the written examination. Please handover this Form along with Original / Photocopy of Rail / Bus Tickets / Receipt and copy of Caste / PWD Certificate (as applicable) to the person authorized to collect in the same venue.