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Pay: Head Qrs. Purpose of Journey: DEPARTURE ARRIVAL Station Date & Hour Station Date Km./ & Mode of Hour Travel 1 2 3 4 DAILY ALLOWANCE 5 Rate/ Class of travels Acutual Fare Paid Hotel Charg es (if any) DAIL Y NO. Of Day 6 7 8 9 Rate Admissi ble 10 **GRAND TOTAL** (DETAILS OF THE CLAIM) 1. Total of Column no. 12 (B.F) Rs.: 2. Terminal Tran.

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