Form for claiming reimbursement for travel, boarding, lodging related to meeting with Mentor Councils 1 Name Shri.Dr. Shailendra Saraf 2 (i) Designation Professor and Director Academic/Professional Institutions (ii) Organisation Institute of Pharmacy Nominated by Pharmacy Council of India, Delhi (iii) Pay/Pay Band (in case of Govt. Official) Faculty of Technology, Institute of Pharmacy, Pt. Ravishankar 3 Address with District/State Shukla University Raipur-492 010 (Chhattisgarh) 4 Phone Number 0771-2262832 / 9826150327 5 E-mail Address shailendrasaraf@rediffmail.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 (132 -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. Shailendra Saraf 2 (i) Designation Professor and Director (ii) Organisation Academic/Professional Institutions Institute of Pharmacy Nominated by Pharmacy Council of India, Delhi (iii) Pay/Pay Band (in case of Govt. Official) 3 Address with District/State Faculty of Technology, Institute of Pharmacy, Pt. Ravishankar Shukla University Raipur-492 010 (Chhattisgarh) 4 Phone Number 0771-2262832 / 9826150327 5 E-mail Address shailendrasaraf@rediffmail.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 (132 -135) / 279 (Signature of claimant) (27.01.2014)
262inviteesdetails-25sectorsAgritoTravel-TADAform-draft.docx