Claim

In lieu of IAFA-194 CDA ACCOUNT NO : ______________ REQUISITION FOR ADVANCE Officers Bankers :

A/C No – AXIS BANK LIMITED ____________________ ____________________ ____________________

Received from the controlled of Defence Accounts (Officers), Pune a sum of Rs ________/- (Rupees _______________ only) on acct of composite grant expenditure on acct of conveyance of baggage from ___________ (Old Duty Stn) to ___________ (New Duty Stn) while move of the offr vide _____________ Sig No _______________ dt ________ 2009. The details of advance are as under :(a)

Composite Transfer Grant (100%) (Basic Pay + Grade Pay + MSP)

Rs ___________/(Rs _____/+_____/-+___/-)

(b)

Conveyance of 60 qtl House hold Luggage by Truck from _______ to ____________

Rs __________

(c)

Conveyance of Car from _____ to _________

Rs ___________

(d) TA/DA ------------------------------------------------------------------------------------Total Rs ___________ --------------------------------------------------------------------------------(e)

Advance applied for

-

Rs ___________

(f)

Date of journey

-

2nd week of Jul 09

(g)

Authority - __________________________________________.

COUNTERSIGNED

Signature with stamp Rank & Name : _______________ No : _______________ Appt & Unit : _______________ PIN-___________ C/o ____________ Dated

:

____ 09

Passed for Rs …………………….. (Rupees …………………………………………………………………… ….) For Payment as under Voucher No : Treasury

Name of Payee

Amount Cheque

Date of Cheque

Initial of Supdt D Sec

Initial of Offr I/C D Sec