शाखा: _________________________, ALPHA:____________, SOL ID: _________

E-mail ID: ________________________, REGION:_____________ दावा/पीएसएस

CLAIM FOR REIMBURSEMENT OF TRAINING EXPENSES WHILE ON TRAINING

1. I, undersigned Mr./Mrs./Ms.___________________________________________
EC.No._____________. Working as_____________________________________(Designation) and drawing Basic
Salary: `_____________ submit my bill / claim for the expenses as under:

2. Purpose of Journey: ______________________________________________

3. Authority: ______________________________________________________

4. JOURNEY DETAILS:

Started at ________a.m./p.m. on_______________ from __________________ to _____________________ by

Railway / Bus / Taxi / AIR / Bank’s car / _______ (other) and reached at ____________________ on _____ at
_______ a.m. / p.m. and returned to Head quarter at _________ a.m. / p.m. on ___________

5. Expenses for Outward Journey: Railway /Bus/AIR __________ (Class) ________________

6. Expenses for Inward Journey:- Railway /Bus/AIR __________ (Class) ________________

7. Diem Allowance ( 1/4 for ______ days ) _________

( 1/2 for ______ days ) _________
( 3/4 for ______ days ) _________
( FULL for ______ days ) _________ ________________

8. Conveyance Charges (Give particulars)

Rickshaw / taxi fare at ______________Rs.______
Rickshaw / taxi fare at ______________Rs.______ ________________

9. Local Conveyance during the Training (If, applicable) Days____ X Rs.______ ________________

10. TOTAL CLAIM Rs.=== ==============

11. Details of Training

SR NO TITLE OF THE TRAINING PLACE FROM DATE TO DATE

12. Details of Residential Accommodation

ACCOMMODATION AT TC AT HOTEL ARRANGE BY TC ON OWN

FOOD PROVIDED BY THE BANK / BREAKFAST LUNCH DINNER

COMPLEMENTARY BY HOTEL

I enclose herewith :-
1. Copy of Boarding Calender/ Training Letter received from Training Cenre/College/Branch/RO/ZO/HO/Other
2. Original Tickets / Boarding Pass
3. Original Hotel Bill/Receipts

Date: ______________ ___________________

Place: ______________ Signature of the Claimant
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FOR BRANCH / OFFICE USE ONLY

CERTIFIED THAT THE CLAIM OF THE ABOVE STAFF MEMBER IS SCRUTINISED AND FACTS STATED IN THE CLAIM,
ELLIGIBLE FOR REIMBURSEMENT OF TE/DA EXPENSES INCURRED BY HIM/HER UNDER THE BOBOSR / BPS.

Verified / Recommended Sanctioned of Rs._________ SPACE FOR PSS / SANCTION

For Bank of Baroda For Bank of Baroda BY HRCPC, BARODA

Manager/Sr. Manager Manager/Sr. Manager/

Chief Manager/AGM