Uttar Pradesh Rural Road Development Agency

Department of Rural Development Government of uttar pradesh

Note: This bill should be prepared in duplicate / one for payment and the other for record as office copy

Part A (to be filled up by the Claimant)

• Name:
• Designation:
• Pay:
• Headquarters:
• Details and purpose of journey performed:

Mode of journey

If a higher rate of Daily Allowance is being claimed for stay in hotel or other establishments proving board and/or lodging at scheduled tariffs, furnish the following particulars, supported by hotel bills/receipts etc.

Particulars of journey(s) for which a class of accommodation higher than the one to which the employee is entitled was used:

If the journey/s by the higher class has been performed with the approval of the competent authority, quote Number and date of the sanction.

Details of journeys performed by road between places connected by rail

Amount of TA advance, if any, drawn.
I am drawing / not drawing transportation allowance @ Rs _____ per month.

Certified that the information as given above, is true to the best of my knowledge and below.

Date ________________________

Signature of the Employee

• Air: Exchange voucher arranged by office
  Ticket / Exchange voucher arranged by
• Rail: Whether traveled by Mail/Express/Ordinary train?
  Whether return ticket available?
  If available, whether return ticket purchased? If not, state reasons.
• Road: Mode of conveyance used, i.e., by Govt. transport / by taking a taxi, single seat in a bus or other public conveyance / by sharing with another employee in car belonging to him or to a third person is to be stated.
• Date of absence from place of halt on account of –
• Restricted holidays and Casual leave taken, if any.
• Day(s) on which the claimant was not actually in camp on Sunday and holidays.
• Dates on which free board and / or lodging was provided by the state or any organization financed by state funds –
  • Board only
  • Lodging only
  • Board and lodging