Form for claiming reimbursement for travel, boarding, lodging related to meeting with Mentor Councils 1 Name Shri.Dr.A.K. Agarwal 2 (i) Designation Dean Academic/Professional Institutions (ii) Organisation Maulana Azad Medical College Member of Health Care Sector Skill Council (iii) Pay/Pay Band (in case of Govt. Official) Maulana Azad Medical College, BAHADUR SHAH ZAFAR 3 Address with District/State MARG, NEW DELHI-110002 4 Phone Number 011-23239271 5 E-mail Address arunmamc@gmail.com 6 Details regarding travel Departure Arrival Receipt/ Distance Amount Ticket Mode of in Kms. claimed/ attached Travel (for travel Date/Time From Date/Time To Fare Paid by road) (Yes/No) 7 Details regarding boarding/lodging Period of Stay Amount paid/to be paid Receipt Name of Hotel attached From To Boarding Lodging Total (Yes/No) Sector Healthcare sector (134 -135) / 279 (Signature of claimant) (27.01.2014)
Form for claiming reimbursement for travel, boarding, lodging related to meeting with Mentor Councils 1 Name Shri.Dr.A.K. Agarwal 2 (i) Designation Dean (ii) Organisation Academic/Professional Institutions Maulana Azad Medical College Member of Health Care Sector Skill Council (iii) Pay/Pay Band (in case of Govt. Official) 3 Address with District/State Maulana Azad Medical College, BAHADUR SHAH ZAFAR MARG, NEW DELHI-110002 4 Phone Number 011-23239271 5 E-mail Address arunmamc@gmail.com 6 Details regarding travel Departure Arrival Amount claimed/ Fare Paid Mode of Travel Distance in Kms. (for travel by road) Receipt/ Ticket attached (Yes/No) Date/Time From Date/Time To 7 Details regarding boarding/lodging Period of Stay Name of Hotel Amount paid/to be paid Receipt attached (Yes/No) From To Boarding Lodging Total Sector Healthcare sector (134 -135) / 279 (Signature of claimant) (27.01.2014)