Indian Institute Of Technology , BOMBAY

P.O.IIT, Powai, Mumbai - 400 076

DATE :

CONVENCE CHARGES BILL

Name of the Prof./Dr./Shri./Smt.:
Claiment & Dept :
Sub. Voucher No. :

Sr. No. Date of Journey PARTICULARS Amount Rs. Ps.
1. From:
  To :
  Purpose ( in brief)
         
2. From:
  To :
  Purpose ( in brief)
         
3. From:
  To :
  Purpose ( in brief)
         
4. From:
  To :
  Purpose ( in brief)
         
5. From:
  To :
  Purpose ( in brief)
         
    Total Rs.

Please mention mode of conveyance if Taxi / Auto is hired quote Taxi / Auto No.

____________________
Signature of the Claiment

Received the reimbursement of the conveyance Charge of Rs. Claimed above.

Signature ___________________

Certified that Prof. / Dr. / Shri. / Smt. (Design) was sent for office work as indicated above and journey performed by his was Essential.

Bill passes for payment for Rs. .

___________________________
(Head/I/C/Dept. Centre/Section)