Form for claiming reimbursement for travel, boarding, lodging related to meeting with Mentor Councils 1 Name Shri. Daljit Singh 2 (i) Designation President Industries (ii) Organisation Fortis Healthcare Ltd Member of Health Care Sector Skill Council (iii) Pay/Pay Band (in case of Govt. Official) Fortis Healthcare Ltd, Tower A, Unitech Business Park, 3 Address with District/State Block F, South City 1, Sector 41, – – Gurgaon, Haryana - 122001 4 Phone Number 0124-4962243 5 E-mail Address daljit.singh@fortishealthcare.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 (129 -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. Daljit Singh 2 (i) Designation President (ii) Organisation Industries Fortis Healthcare Ltd Member of Health Care Sector Skill Council (iii) Pay/Pay Band (in case of Govt. Official) 3 Address with District/State Fortis Healthcare Ltd, Tower A, Unitech Business Park, Block – F, South City 1, Sector – 41, Gurgaon, Haryana - 122001 4 Phone Number 0124-4962243 5 E-mail Address daljit.singh@fortishealthcare.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 (129 -135) / 279 (Signature of claimant) (27.01.2014)
262inviteesdetails-25sectorsAgritoTravel-TADAform-draft.docx