(a) Name (e) Journey on Tour/Transfer (b) Designation (f) Pay and Special Pay Rs. (c) Department/Office (d) Headquarters (See Rule 160 of O.T.A. Rules) Application Form for Travelling Allowance Schedule LIII-Form No.72 Government of Orissa (g)Amount of advance drawn Rs. For this journey. (h)Particulars of family members For whom T.A. is claimed Published on National Portal of India (india.gov.in) /-/- Commerce & Transport (Commerce) Department Rs. Rs. Rs. /- Arrival Place Date Time Place Date Time Distance Purpose of Departure journey 1 2 3 4 5 6 HH:.MM Published on National Portal of India (india.gov.in) HH:MM HH:MM HH:MM HH:MM HH:MM Published on National Portal of India (india.gov.in) Mode of journey Fare paid Air/Rail/Road, etc. for train journey and Conveyance & transport charges Charges, if any paid for accommodation [under Rule 65 (d)1] REMARKS (Indicate whether leave or free hospitality if any availed) Type of train and class conveyance used for road journey Cost of propulsion 7 8 9 10 Signature of the Claimant Signature of the Controlling Officer /-Rs./-Rs. /-Rs. /-Rs. /-Rs. /-Rs. Arrival Place Date Time Place Date Time Distance Purpose of Departure journey 1 2 3 4 5 6 HH:MM HH:MM HH:MM HH:MM HH:MM HH:MM Published on National Portal of India (india.gov.in) Mode of journey Fare paid Air/Rail/Road, etc. for train journey and Conveyance & transport charges Charges, if any paid for accommodation [under Rule 65 (d)1] REMARKS (Indicate whether leave or free hospitality if any availed) Type of train and class conveyance used for road journey Cost of propulsion 7 8 9 10 Signature of the Controlling Officer Signature of the Claimant Published on National Portal of India (india.gov.in) /-Rs./-Rs. /-Rs./-Rs. /-Rs./-Rs.
