Ta Bill Form
Ta Bill Form
DISTRICT: ___________________________________
Mode
Departure Arrival Fare Distance Purpose of
of D.A.
Date/Time From Date/Time To paid In Kms Journey
Travel %
Page - 2
6. Date of absence from place of halt on account of (a) R.H. and C.L.
7. Date on which free boarding and/or lodging provided by the state or any organization
financed by State Funds: -
----- NIL ----
8. Particulars to be furnished along with Hotel receipts etc., in case where higher rate of
D.A. is claimed for stay in Hotel/other establishments providing Board and/ or
lodging at scheduled tariff:-
9. Particulars of Journey(s) for which higher class of accommodation than the one to
which the Government servant is entitled was used.
CERTIFICATE
1 Certified that the information as given above is true to the best of my knowledge
and belief.
2 Certified that I give my option for availing DA on tour as per Ministry’s order dated
17th April 1998 in regard to TA. (Strike out this point if opting to claim as per new
TA rules as per 6 CPC)
List of Enclosures
CHECKED BY
NAME : _____________________
DESIGNATION: _____________
JNV : _____________________
Page - 3
(FOR OFFICE USE ONLY)
c) Daily Allowance
_________________________________________________________________________ Only.)
Initial of
Bill Clerk.
Signature of DDO/ACAO