Form for claiming reimbursement for travel, boarding, lodging related to meeting with Mentor Councils 1 Name Shri.Dr.K.N Tewari 2 (i) Designation Professor Academic/Professional Institutions (ii) Organisation IIT Nominated by Indian Institute of Technology, Kharagpur (iii) Pay/Pay Band (in case of Govt. Official) Indian Institute of Technology Kharagpur, Kharagpur 3 Address with District/State India - 721302 4 Phone Number 9434944443 5 E-mail Address 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 Agriculture, Horticulture and Floriculture sector (11-11) / 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.K.N Tewari 2 (i) Designation Professor (ii) Organisation Academic/Professional Institutions IIT Nominated by Indian Institute of Technology, Kharagpur (iii) Pay/Pay Band (in case of Govt. Official) 3 Address with District/State Indian Institute of Technology Kharagpur, Kharagpur India - 721302 4 Phone Number 9434944443 5 E-mail Address 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 Agriculture, Horticulture and Floriculture sector (11-11) / 279 (Signature of claimant) (27.01.2014)