RECEIPT

I/ Received from the

Registrar,

Indian Institute of Technology, Powai, Bombay the sum of Rs.    ( Ruppes )

being my reimbursement of medical charges/balance of T.A./ Advance under Tour/L.T.C./ Consultative Practice Fund / Honorarium.


Revenue
Stamp
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AUTHORITY

I hereby authorise Shri/Smt. to receive the sum of Rs.

Rupees being my reimbursement of medical charges/balance of T.A./Advance under

Tour / L.T.C /Consultative Practice fund/Honorarium.




SIGNATURE