TA-DA Form

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Honorarium/TA/DA Bill
1. Name:- (In Block Letters) 2. Father's Name:-
3. Address:- Contact No:-
4. Designation:- 5. Organization:-
6. Pay Scale/ Consolidated Salary:- 7. Grade Pay:-
8. Date of Meeting/ Inspection:- 9. Purpose of Meeting & Journey:-
10. Last Pay Scale & GP If Retired:- 11. E-mail ID:-
12. Bank A/c No. (For ECS Payment):- Bank IFS Code:
13. PAN:-
(A) Honorarium:-
S. No. Particulars Date No. of Days Rate of
Total Amount
From To
Total (A):-
(B) TA/DA/Local Journey/Toll Tax etc.:-
Departure Arrival Mode of Journey & Vehicle No. Distance for Road Mileage Amount of Toll Tax etc. Hotel/ NON Hotel D.A. Total Amount (Rs.)
Date Station Time Date Station Time K.M. Rate
Please add additional form if required Total (B):-
(C) Accommodation / Lodging Claim
City Place Hotel Name & Address Bill No. Check IN Time/Date Check OUT Time/Date Room Rent Per Day No. of Days Total Amount (Rs.)
Total (C):-
Grand Total: A+B+C =
Certified that:-
(i) Particulars provided herewith are correct & that I have not claimed TA/DA for this Journey from any other Public Source and bill is submitted first time.
(ii) I was not provided free lodging and/or boarding at the cost of Govt. /University or any autonomous body if provided please attach Boarding/ Lodging/ Both Bills.
(iii) Certified that I shall perform the return journey from. to in class.
(iv) Certified that the I have travelled by shortest route and I will perform return Journey by same route and mode of Conveyance/ as claimed and mode of conveyance.
The above Meeting/ Journey claim is verified to be true & correct.

Verified By:-
Signature of Claimant
Sign. & Name of Officer (Concerned Department)

For Use by Accounts Office Only
Head of Account:- Passed for Rs/-

Or return in original with remarks as attached.
Dealing Clerk Assistant Registrar Director Finance
Note: The information entered above is not stored in the system and cannot be retrived in future.