LFkk;h LFkkuh; okgu [kpksza dh izfriwfrz Reimbursement of Fixed Local Conveyance Expenses

Transkript

1 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ( Hkkjr ljdkj dk m e ) ( A Government of India Enterprise ) LFkk;h LFkkuh; okgu [kpksza dh izfriwfrz Reimbursement of Fixed Local Conveyance Expenses Name &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Designation &&&&&&&&&&&&&&&&&&&&&&&&&&& dezpkjh la- / Employee No. &&&&&&&& fohkkx / Department &&&&&&&&&& osrueku / Pay Scale (Rs.) &&&&&& d- lr;kfir fd;k tkrk gs fd esaus &&&&&&&&&&&&& ds nksjku dk;kzy;h dk;ksza ij &&&&&&& :Ik;s (&&&&&&&&&&&&&&&&&&&&&&& :i;s ) [kpz fd;s gsaa A. Certified that for official work during the month of. I have spent more than Rs. /- ( Rs. ). 1- esjh eksvj lkbfdy dk iathdj.k la[;k &&&&&&&&&&&&&&&&&& dk LokfeRo vksj mldk j[k&j[kkoa For maintenance and possession of my Car / Scooter / Motorcycle Registration No. 2- okgu j[krs without maintaining vehicle. [k- iwu% lr;kfir fd;k tkrk gs fd ekg ds nksjku esa &&&&&&&&&&&& ls &&&&&&&&& rd NqVVh ij rfkk &&&&&&&&&&& ls &&&&&&&& rd ;k=k@hkze.k ij FkkA Futher certified that I was on leave from to and on tour from to during the month. x- iwu% lr;kfir fd;k tkrk gs fd ekg ds nksjku esaus deiuh dk dksbz okgu iz;ksx ugha fd;k gsa Futher certified that I have not availed any company s transportation during the month. fnukad / Dated : ( nkosnkj ds glrk{kj ) fu;a=.k Controlling Officer ( Signature of the Claimant ) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& forr,oa ys[kk fohkkx ds iz;ksxkfkz Receipt Use of Finance & Accounts Department Rs. :Ik;s ds fy, ikl fd;ka Passed for Rs.. mijksdr gsrq,p,l lh lh ls Rs. izkir fd;s x;sa Received Rs. From H S C C for above. mi izca/kd ( forr,oa ys[kk ) Deputy Manager ( F & A ) Cashier Date % Signature &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& uksv % & 1-10 fnu ;k mlls vf/kd fnu NqVVh ;k Hkze.k ij jgus dh flfkfr esa izfriwfrz vkuqikfrd vk/kkj ij dh tk;sxha If on leave or on tour for more than 10 days then reimbursement will be proportionate. 2- ;g izi= gj eghus dh 3 rkjh[k rd forr,oa ys[kk fohkkx esa igqwap tk;s rfkk 5 rkjh[k rd Hkqxrku dj fn;k tk;sa This form should reach F & A Department on or before the 3 rd of each month and payment will be made on 5 th of each month. 3- tks ykxw uk gks mls dkv fn;k tk;sa Delete which is not applicable.

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8 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ( Hkkjr ljdkj dk m e ) ( A Government of India Enterprise ) NqV+Vh ds fy;s vkosnu LEAVE APPLICATION FORM 1- Name &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Designation &&&&&&&&&&&&&&&& fohkkx / Department / Site &&&&&&&&&&&&&&&& dezpkjh la- / Employee No. &&&&&&&&&&& 2. NqV~Vh dh fdle ls rd fnuksa dh la[;k Type of Leave From To No. of Days a) vkdfled vodk Casual Leave b) izfrcfu/kr vodk Restricted Leave c) vftzr vodk Earned Leave d) fpfdrlk vodk Medical ( H P ) Leave e) fpfdrlk vodk Medical ( F P ) Leave f) fo ks k vkdfled vodk Special Casual Leave g) vlk/kkj.k vodk Extra Ordinary Leave ( fcuk osru ) / ( Without Pay ) 3. Purpose D;k lsok LFkku NksM+uk Whether Leave Station NqV+Vh ds nksjku laidz ds fy, Contract Address during Leave..... lalrqr djus okys vf/kdkjh ds glrk{kj Recommended by Date. vkosnd ds glrk{kj Signature of Applicant fnukad / Date eatwj djus okys vf/kdkjh ds glrk{kj Sanctioned by Date

9 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ( Hkkjr ljdkj dk m e ) ( A Government of India Enterprise ) iv~vs ij fy;s x;s vkokl dh ejeer,oa j[k&j[kko gsrq izfriwfrz Reimbursement For Repairs And Maintenance of Leased Accommodation Name &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Designation &&&&&&&&&&&&&&&&&&&&&&&&&&& dezpkjh la- / Employee No. &&&&&&&& fohkkx / Department &&&&&&&&&& osrueku / Pay Scale (Rs.) &&&&&& iv+vs ij fy;s x;s vkokl dk irk &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Address of Leased Accommodation &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& ekfld Monthly Rent ( :i;s / Rs. ) &&&&&&&&&&&&&&&&&&&&&& d- lr;kfir fd;k tkrk gs fd esaus &&&&&&&&&&&&& ls &&&&&&&&&&&&&&&&& ds nksjku iv+vs ij fy;s x;s mijksdr vkokl dh ejeer,oa j[k&j[kko gsrq Rs./:i;s &&&&&&&&&&&&&&&&& (&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& :i;s ) [kpz fd;s gsaa A. Certified that during the month from to. I have spent more than Rs. ( Rupees ) towards Repairs & Maintenance of above Leased House. fnukad / Dated ( nkosnkj ds glrk{kj ) fu;a=.k Controlling Officer ( Signature of the Claimant ) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& ekuo lalk/ku izca/ku fohkkx iz;ksxkfkz For Use of HRM Department mppre fu/kkzfjr gd+nkjh Rs. / :Ik;s ( :Ik;s ) Ceiling / Entitlement Rs. Rs. ) Rs. ( Rupees ) ds fy, gdnkj,oa LkO;kfir fd;ka Verified & Entitlement for Rs. Rs. ) mi&ekgkizca/kd ( ek la iz ) / DGM ( HRM ) izca/kd ( ek la iz ) / MANAGER ( HRM ) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& forr,oa ys[kk fohkkx iz;ksxkfkz Use of F & A Department Rs. :Ik;s ds fy, ikl fd;ka ( Rupees / :i;s ) Passed for Rs. mi&ekgkizca/kd ( fo-,oa ys- ) / DGM ( F & A ) mi&izca/kd ( fo-,oa ys- ) / D M ( F & A ) &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Receipt mijksdr lanhkz esa],p,l lh lh ls &&&&&&&&&&&& :Ik;s izkir Received Rs. from HSCC for above. Date % Signature

10 dezpkjh la[;k Js.kh % vkbz vks bz Mh Employee No. &&&&&&&&&&&&&& Category : I O E D,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) 1. dezpkjh dk uke,oa in 2- ejht+ dk uke,oa laca/k Name & Designation Name of Patient & Relationship of the Employee 3. ewy osru ( :i;s )./ Basic Pay ( Rs. ).. / iz;ksx kkyk dk uke &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Name of the Hospital / Clinic / Laboratory 5. nkok dh x;h izfriwfrz;ksa dk fooj.k Particulars of Reimbursement claimed i) vkbz lh ;w ds Room / I. C. U. Charges Rs... ii) ijke kz Consultation Charges Rs... iii nokbz;ksa dk Cost of medicines Rs... iv) iz;ksx tkwap [kpsz Rs... Pathological / Laboratory / Test charges v) Vhdkdj.k Vaccination charges Rs... vi) ckg++;&fpfdrlk Physiotherapy charges Rs... vii) vkwijs ku Operation charges Rs... viii) vkwijs ku ffk;svj ds Operation Theatre charges Rs... ix),uslfkhfl;k Anesthesia charges Rs... x) nar Dental Charges Rs... xi) us= Eye Treatment Rs... xii) dksbz vu; Any other Charges Rs... ( d`ik;k fooj.k nsa / Please give details ) dqy / Total = Rs... ( :Ik;s / Rupees ) esa lr;kfir djrh gwwa fd fn;k x;k mijksdr fooj.k esjs vius esjs ifjokj ds lnl; ds bykt ds fy, [kpz fd;k x;k gs ] tksfd,p,l lh lh fpfdrlk izfriwfrz fu;ekoyh ds vuqlkj fy;k x;k gsa I certify that the particulars given herein are correct and the expenditure has been incurred for medical treatment of self and / or member of my family as defined in the HSCC Medical Reimbursement Rules. fnukad / Date : ( dezpkjh ds glrk{kj ) (Signature of the Employee)

11 - : ( 2 ) : - dezpkjh la[;k % Employee No. : tkap fy;k x;k gs] lr;kfir,oa lalrqfr dh tkrh gs fd fuefufyf[kr vuqlkj :i;s &&&&&&&&&&&& dk Hkqxrku fd;k tk;sa Checked, verified and passed for payment of Rs. as per following details : (i) ijke kz@nokbz;ksa Consult/Medicine : (ii) O;kf/kd@iz;ksx kkyk@tkwap [kpsz Pathological / labratory / Test charges (iii) Vhdkdj.k [kpsz@vaccination charges (iv) vu; [kpsz@other Charges ( :i;s / Rs. ) ofj B dk;zikyd dk;zikyd lgk;d izca/kd ( ek- la- iz-) Sr. Executive Assistant / Executive Assistant Manager ( H R M ) Rs. / :i;s &&&&&&&&&&&& ds Hkqxrku ds fy, ikl fd;k tkrk gsa Amount to be Paid Rs.. ( :i;s / Rs. ) mi&izca/kd / izca/kd ( foùk,oa ys[kk ) Dy. Manager / Manager ( F & A ) Notes : izr;sd Js.kh tsls ; ^^ vkbz ** ( vkarfjd / Indoor ) ^^ vks ** ( ckg~; / Outdoor ) ^^bz **( vka[k / Eye ) ^^Mh ** ( nkar / Dental ) ds [kpksza dh izfriwfrz;ksa ds Hkqxrku ds fy, vyx&vyx Hkjs gq;s fcy tek fd;s tk;saa Separate bill should be submitted for claiming reimbursement of expenditure under each category i.e. I ( Indoor ) or O (Outdoor ) or E ( Eye ) or D ( Dental ). Tick mark the appropriate category in the claim form. 2. MkDVjksa }kjk lq>k;s fn;s x;s lhkh vks k/k&funsz kuksa] eseks rfkk lacaf/kr vu; lhkh nlrkostksa dks ewy :Ik esa dzeokj,oa fnukad vuqlkj layxu djsaa vf/kdre 5 nlrkost gksus dh flfkfr esa] [kpksza dk nkok dh x;h izr;sd lkj.kh&lhv ds lkfk ] ftlesa [kpsza n kkz;s x;s gksa] layxu All the prescriptions, each memos and other relevant documents should be enclosed in original and serial numbered date wise. In case, the number of enclosures is more than five, a summary sheet of expenditure claimed under each head shown in the claim form should be given. Receipt :- izkir fd;k / Received Rs. ( :Ik;s / Rupees dsoy / Only ). Date :-- Signature

12 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) NqV+Vh ds fnu dk;z djus gsrq fuosnu Ik= REQUISITION TO WORK ON HOLIDAYS Name %& &&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&&&&&&&& Department %& &&&&&&&&&&&&&&&&&&&&&&&&& Date %& &&&&&&&&&&&&&&&&&&&&&&&&& dk;kzy; esa :dus dk yxhkx le; %& &&&&&&&&&&&&&&&&&&&&&&&&& Appx duration of stay at Office dk;z dk mnns ; %& &&&&&&&&&&&&&&&&&&&&&&&&& Purpose of Work ( Signature ) fohkkx izeq[k ds glrk{kj Signature of the Head of the Deptt./Controlling Officer izca/kd ( ekuo lalk/ku izca/ku ) Mgr./Sr. Mgr ( H R M )

13 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) uklrk izfriwfrz izi= ( Snacks Reimbursement Form ) dk;z Work Day % &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& mnns Purpose % &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& jkf k ( :Ik;s ) / Amount (Rs) % &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& ( kcnksa In Words ) Rs / :i;s &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& v/kksglrk{kjh us mijksdr dk;z fnolksa esa jkf= ls jkf= rd mijksdr mn~ns ; ls dk;kzy; esa dk;z fd;k gsa bl lanhkz esa eq>s mijksdr jkf k dh izfriwfrz dh tk;sa Certified that I have worked at Office on the above mentioned date(s) from AM / PM to AM / PM and spent the said amount for snacks which may please be reimbursed to me. Signature : iwjk Full Name : dezpkjh Employee No. : Date : fu;a=d vf/kdkjh ds glrk{kj Controlling Officer s Signature Sr. Mgr (HRM) : Passed for Payment Rs. /- mi&izca/kd ( forr,oa ys[kk ) Deputy Manager ( F & A )

14 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) fdlh fo ks k mís ; ls C;kt jfgr vfxze ysus gsrq vkosnu Ik= APPLICATION FOR INTEREST FREE ADVANCE FOR ANY SPECIFIED PURPOSE 1- iwjk Name in Full : 2- dezpkjh Employee No. : 3- in,oa Designation & Department : 4- ewy osru + eagxkbz Basic Pay + DA : 5- fu;qfdr dh Date of Joining : 6- lafofnr ( Bsds ij ) Whether Regular / Contract : 7- pkgs orzeku dsysamj o kz ds nksjku vfxze fy;k x;k Whether Advance has been : drawn During the Current Calendar Year 8- finyk Outstanding Balance : 9- vfxze dk mís Purpose of Advance : 10- izfr ekg olwyh Recovery Rate Per Month : mijksdr fooj.k vuqlkj eq>s Rs ( Rupees ) C;kt jfgr vfxze jkf k iznku djus dk d V I may kindly be granted Interest Free Advance amounting to Rs. ( Rupees ) as per details given above. ( dezpkjh ds glrk{kj ) fu;a=d vf/kdkjh / eq[; egkizca/kd ( Signature of Employee ) Controlling Offcer / Chief General Manager Date : mijksdr fn;s x;s mn~ns ; gsrq Jhefr dks Rs (:i;s@rupees ) jkf k vfxze nsus ds fy;s vuqeksfnr fd;k tkrk gsa :Ik;s@Rs. jkf k dh fdlrksaa ls olqyh dh Advance of Rs. /- (Rupees ) only is passed for payment to Shri/Smt for the purpose mentioned above. The amount is recoverable in equal instalments of Rs.. Note %& lafofnr dezpkfj;ksa dks deiuh }kjk fu/kkzfjr ca/k Ik= ( Surety Bond ) nsuk vfuok;z gsa A Surety Bond in prescribed format is to be submitted by the employees on Contract Pay Scales. ofj B&izca/kd ( ek- la- iz- ) Sr. Manager ( H R M ) izca/kd ( fo-,oa ys- ) Manager ( F & A )

15 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) izos k & Ik= GATE PASS fueufyf[kr olrqvksa dh LFkkukarj.k gsrq mugsa dk;kzy; ifjlj ls ckgj ys tkus ds fy, vuqefr nh tkrh The following may please be allowed to be taken outside the office premises for repairs/replacement/shifting/ : olrq dk uke,oa Name of the item & Quantity cuh dze la[;k Make / Model / Serial No. : : dgka ys tk;h Place to be taken : fdlds By Whom : Date olrq dc rd okil vk tk;sxh ( fnukad ) Expected Date of Return ( Date ) : : fohkkx&izeq[k ds glrk{kj Signature of H O D ( inkf/kdkjh ds glrk{kj ) ( Signature of official ) ofj B izca/kd ( ek- la- iz- ) Manager / Sr. Manager ( H R M ) Signature of Company / Agency Representative : ds izfrfuf/k ds glrk{kj : Received back in the office on by. dk;kzy; esa fnukad dks }kjk olrq iwu% izkir dh x;ha ofj B&izca/kd ( ek- la- iz- ) Sr. Manager ( H R M ) ( izkir djus okys inkf/kdkjh ds glrk{kj ) ( Signature of Receiving Official )

16 ,p,l lh lh dezpkjh dy;k.k dks k U;kl HSCC EMPLOYEES WELFARE FUND TRUST Nk=o`fÙk dh nkosnkjh gsrq vkosnu Ik= Application Form for Claiming Scholarship dkfezd,oa iz kklfud fohkkx ds ifji= fnukad 03 ebz] 2000] ifji= la[;k,p,l lh dk-,oa iz kk-@2000@2 ds lanhkz esa] esa vius cppksa dh Nk=o`fÙk gsrq vkosnu djuk pkgrh gwwa] ftldk fooj.k fueukuqlkj gsa In terms of P & A Department Circular No.HSCC/P&A/2000/2 Dated May 03, 2000, I hereby apply for award of scholarship in respect of my ward, whose details are give below : cpps dk Name of Ward : d{kk ] ftlds fy;s nkosnkjh dh tk jgh gs Class for which Scholarship is claimed : IkzkIr vadksa dk izfr kr Percentage ( % ) of marks : mijksdr lanhkz esa] nlrkost+ layxu dj fn;s x;s gsaa Documentary proof in respect of the above is enclosed. ( dezpkjh ds glrk{kj ) (Signature of the Employee) dezpkjh dk uke : Name of Employee : Dated : ekuo lalk/ku izca/ku fohkkx ds iz;ksxkfkz For Use of H R M Department mijksdr fd;s x;s nkos dks lr;kfir dj fy;k x;k gsa vr%] ge,p,l lh lh dy;k.k dks k VªLV ls :i;s dk Hkqxrku djuk izlrkfor djrs gsaa The claim has been verified. It is proposed that we may release an amount of Rs. from the HSCC Employees Welfare Fund Trust. izca/kd (ek-la-iz-) / ofj B izca/kd ( ek-la-iz-) Manager ( HRM ) / Sr. Manager ( HRM ) lfpo] dy;k.k VªLV Secretary, Welfare Trust dks kk/;{k] dy;k.k VªLV Chairman / Treasurer, Welfare Trust

17 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) fjlksvz ( kj.k&lfky ) dh cqfdax gsrq fuosnu Requisition for Resort Booking 1. Name : 2. dezpkjh Employee No. 3. Designation : 4. Department 5. fuokl&lfkku,oa nwjhkk k : Residence & Phone No. 6. Hkze.k Visiting Resort(s) : ( ojh;rk vuqlkj fodyi ) ( Options Preference wise ) 7. :dus dh Period of stay 1. psd&bu fnukad / Check-In Date : psd&vkmv fnukad / Check-Out Date : 2. psd&bu fnukad / Check-In Date : psd&vkmv fnukad / Check-Out Date : OR Particular Resort Option of Weeks ( Preference Wise ) fjlksvz dk fooj.k g rksa dk fodyi ( ojh;rk vuqlkj ) NqfÍ;ksa dk Vh lh,oa vof/k % Type of Leave / LTC & Period : 9. ifjokj dk Particulars of Family Øe la[;k uke ( Jh@Jhefr ) vk;q laca/k Sr.No Name ( S/Shri ) Age Relationship ( dezpkjh ds glrk{kj ) Date : - ( Signature of the Employee ) ( ekuo lalk/ku izca/ku fohkkx gsrq For Use of HRM Department ) mijksdr fooj.k dh tkap dj yh x;h gs rfkk lr;kfir fd;k tkrk The above particulars have been checked & verified. mi&egkizca/kd ( ih- vkj- ) / DGM ( P R )

18 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) ;k=k HkÙkk fj;k;r ds izfriwfrz gsrq vkosnu APPLICATION FOR GRANT/ENCASHMENT OF LEAVE TRAVEL CONCESSION 1. vkosnd uke,oa : Name & Designation of Applicant : 2. fohkkx,oa fu;qfdr LFky Department & Place of Posting : 3. dezpkjh la[;k Employee No. : 4. ewy osru vkbz Lkh Mh, Pay Scale I D A / C D A : 5.,p,l lh lh esa fu;qfdr dh fnukad Date of joining in HSCC : 6. eatwj dh x;h NqfVV;ksa dh vof/k,oa izdkj Nature & Period of Leave Sanctioned : 7.(a) x`g Home-Town / Place : (b) x`g LFkku ds vfrfjdr Other than Home Town / Place : 8. CykWd Ok kz ftlds fy;s,y Vh lh yh tk jgh gs Block year for which LTC is Sought : 9. finyh,y Vh lh dc yh x;h] fnukad crk;sa ( ;k=k dh fnukad crk;sa ) : Date on which LTC was Last Availed of ( Here give Date of Journey ) : 10. jsy ;k=k dh Class of Rail Travel : (a) fdlds fy, gdnkj To Which Entitled : (b) vkosnd dslh ;k=k djuk pkgsxk % By Which Applicant Proposes to Travel : 11. Persons including Self, in respect of Whom LTC Advance is Claimed : dze la[;k Serial No Name Total vk;q Age laca/k Relationship vxzorhz ;k=k Onward Journey izdkj Mode jkf k Amount okilh ;k=k Return Journey izdkj Mode jkf k Amount

19 12. dqy jkf k ( vxzorhz,oa okilh ) Total Amount ( Onward & Return ) : 13.(a) fdruh jkf k vfxze pkfg, Amount of Advance Required : (b) Hkqxrku dh jkf Amount of Encashment : 14. lr;kfir fd;k tkrk Certified that : (a) bl CykWd o kz ds nksjku esaus igyh ckj NqV dk ykhk fy;k ys jgh I am availing of the concession for the First Time during the Block Years. (b) esa vksj esjs ifjokj ds lnl; ftudh ;k=k gsrq esaus tks mijksdr Dyse fy;k gs] os eq> ij iwjh rjg vkfjr The family Members in respect of whose Journey(s), the advance is being claimed, are entirely Dependent on me. (c) fd esjh iruh@ifr deiuh esa dk;zjr ugha gsa og vyx ls dksbz NqV dk ykhk ugha mbk jgh@jgk gsa That my Wife / Husband is not a company Employee. He / She has not availed of the concession separately. LkR;kfir fd;k tkrk gs fd mlh Js.kh dh ;k=k(,a) dh tk jgha gsa ] ftuds fy;s mijksdr vfxze fy;k x;k That the Journey(s) shall be performed by the class of accommodation for which the advance has been drawn. 15. esa opu nsrk gwwa I Undertake : (a) (b) fd ;fn vxzorhz ;k=k 90 fnu ds Hkhrj ugha dh x;h rks ] esa rrdky fy;k x;k vfxze iwjk okil dj to refund the advance in full forthwith if the onward journey is not commenced within 90 days of the drawal of advance. fd esa viuh ;k=k iwjh gksus ds 15 fnu ds Hkhrj NqVVh pk=k NwV gsrq fy;s x;s vfxze dk fuivkjk dj to submit the Leave Travel Concession claim in adjustment of the advance drawn within 15 Days of completion of the Return Journey. ( dezpkjh ds glrk{kj ) (Signature of the Employee) fu;a=d vf/kdkjh ds Controlling Officer s Signature Dated : ( ekuo lalk/ku izca/ku fohkkx For Use of HRM Department ) mijksdr fooj.k ds lanhkz esa fy;s x;s vfxze dk lr;kiu dj fy;k x;k gs rfkk,y Vh lh jftlvj esa Ik` V la[;k ij ntz dj fy;k x;k gs] Rs. ds fy;s larqfr dh tkrh The above details and advance/encashment applied for have been verified and recommended for Rs. and entered in the LTC Register at Page No.. lsok vfhkys[k@lgk;d izca/kd ( ek la iz ) Copy for Service Record / Asstt Manager ( H R M ) ( ekuo lalk/ku izca/ku fohkkx For Use of F&A Department ) mi&izca/kd izca/kd ( forr,oa ys[kk ) Deputy Manager/Mgr ( F & A )

20 Receipt,y Vh Hkqxrku ds :i esa ],p,l lh lh ls Rs. ( Rupees / :Ik;s ) /ku;okn lfgr izkir fd;k x;ka Received with thanks from HSCC, Rs. (Rupees ) as LTC Advance / Encashment. ( dezpkjh ds glrk{kj ) (Signature of the Employee) Dated : Note : - 1. leiw.kz Hkkjr&o kz dh,y Vh lh fdlh,d rjqk Js.kh dh 2500 fdyksehvj fu/kkzfjr dh x;h gs] ftlesa ifjokj ds pkj lnl; tsls ; Lo;a ] vkfjr (ifr@iruh)] vkfjr nks cpps kkfey Encashment of All India LTC is limited to 2500 kms each way as per entitled class, restricted to four persons of family i.e. self, spouse & two dependent children only. 2. vkf kad,y Vh Hkqxrku ds ekeys esa],y Vh lh Hkqxrku dh dqy jkf k dk ifjokj ds pkj lnl;] tsls ; Lo;a ] vkfjr ( IkRuh )] vkfjr nks cpps ykhk mbk In case of partial availing / encashment of LTC, the total availing / encashment of LTC will be restricted to four persons of family i.e.self, spouse & two dependent children only. 3.,y Vh lh lqfo/kk dk ykhk dezpkjh dsoy Lo;a ] vkfjr ( iruh ) rfkk vf/kd ls vf/kd rhu vkfjr cpps gh mbk ldrs For availing, LTC shall be restricted to self, spouse & maximum of three dependent children

21 ,p,l lh lh dezpkjh dy;k.k dks k U;kl HSCC EMPLOYEES WELFARE FUND TRUST /kjsyq f k{k.k gsrq C;kt jfgr vfxze ds fy, vkosnu Application for Interest Free Advance for Home Appliances / Study Loan uke / Name dezpkkjh la[;k / Employee No. in / Designation fu;qfdr LFkku / Place of posting : : : :,p,l lh lh esa fu;qfdr dh fnukad / Date of joining in HSCC : ewy osru / Basic Pay ( Rs ) vkosfnr vfxze jkf k / Amount of advance applied for [kjhnh tkus okyh izlrkfor olrqvksa dk C;kSjk List of items proposed to be bought : : : mijksdr gsrq yxhkx jkf k / Appx. Value of above : (Rs) esa lr;kfir djrh gwwa fd fn;k x;k mijksdr fooj.k lr; gsa I hereby certify that the particulars mentioned above are correct. Date : Signature : lr;kfir,oa }kjk vuqeksfnr : ( fjiksfvzax fohkkx&izeq[k }kjk glrk{kj ) Verified & Approved By : ( Signature By Reporting HOD ) mi&egkizca/kd ( ekuo lalk/ku izca/ku ) / D G M ( H R M ) :Ik;s / Rs. ds Hkqxrku gsrq lalrqfr dh tkrh gs / Recommended for payment. lfpo / dks kk/;{k,p,l lh lh dy;k.k U;kl / Secretary / Treasurer HSCC Welfare Trust vuqeksnu for Approval Please : - v/;{k],p,l lh lh dy;k.k U;kl / Chairman, HSCC Welfare Trust ,p,l lh lh dy;k.k dks k U;kl ls vfxze jkf k dk mijksdr lanhkz esa fnukad :Ik;s dk psd u- izkir fd;k x;ka Received Rs. by cheque No. dated from HSCC Welfare Fund Trust towards above advance. Signature : Jherh ds osru ls ekg ls izfrekg :Ik;s olwys tk;saa Recovery of Rs PM may be started from the salary of Shri from the month of. lfpo / dks kk/;{k,p,l lh lh dy;k.k U;kl / Secretary / Treasurer HSCC Welfare Trust Copy to F & A Deptt Note : - 1. vf/kdre vfxze lhek 4 eghus dk ewy osru ;k fqj midj.k ;k olrq dh 1, 00,000/- :Ik;s ls de rd jkf k yh tk ldrk gsa Advance is limited to 4 months basic pay subject to a maximum of Rs.1, 00,000/- or value of equipment, whichever is less. 2. dqy olqyh ewy osru rfkk Mh-,- dk nks frgkbz ds :Ik esa dh tk;sa Total Recovery should not exceed 2/3 rd of basic pay & DA. 3. deiuh }kjk fu/kkzfjr ca/k Ik= ( Surety Bond ) lelr dezpkfj;ksa dks nsuk vfuok;z gsa / A Surety Bond in prescribed format is to be submitted by all the Employess. 4. vfxze yh x;h jkf k ds 30 fnu ds Hkhrj olrq dk fcy@jlhn nsuk gksxk] 18% izfro kz ds fglkc ls C;kt olqy fd;k Bills / Receipts must be submitted within 30 days of drawal of advance failing which interest will be 18% p.a.

22 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ;k=k & HkÙkk vfxze ds vuqnku gsrq vkosnu APPLICATION FOR GRANT OF T. A. ADVANCE 1. uke,oa dezpkjh Name & Employee No. : 2. Designation : 3. osrueku ( :Ik;s ) / Pay Scale (Rs) : 4. dgka tkuk Place of Visit : 5. Hkze.k dh Period of Tour : From To 6. Hkze.k dk mnns Purpose of Journey : 7. Hkze.k dk Tour Approval (copy to enclose) : 8. gokbz Rail/Bus/Air Fare : 9. nsfud Daily Allowance : 10. fjgk;lh Accommodation Charges : 11. ifjogu & Transportation : 12. Others : 13. dqy Total : 14. vfxze ;k=k HkRrs gsrq T. A. Advance Applied for : ( vkosnd ds Signature of Applicant ) Date : ( forr,oa ys[kk fohkkx gsrq For Use of F & A Department ) Vh-,- ( T. A. ) vfxze ds :Ik esa Rs. (:Ik;s ) dh vnk;xh dh tk;sa Passed for Rs. ( Rupees ) as TA Advance. mi&izca/kd /izca/kd ( forr,oa ys[kk ) Dy. Mgr. ( F & A ) / Manager ( F & A) Receipt mijksdr gsrq,p,l lh lh ls izkir fd;s Received from H S C C for above. Date: % :. : Rs. Signature :

23 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ;k=k HkRrs ds fuivkjs gsrq fuosnu Requisition for T.A. Settlement ;k=k laca/kh fcy Travelling Bill Name : Designation : Employee No. Location : Period of Tour : Purpose of Tour : 1. ;k=k dk fooj.k / Details of Journey Date Dept Place Dept Time Arr.Place Arr.Time Mode of travel Tkt.No Fare Total 2. Local Conveyance 3. Daily Allowance Date Mode From To Amount Date Rate Per Day Amount Remarks Total Total 4. euksjatu / Entertainment/Other Exp. 5. vu; [kpsz / Hotel Expenses(Accommo) Details Bill No Date Amount Details Bill No. Date Amount Total Total 2/-

24 - : 2 : Summary of Account Amount Details of Refund Expenses Code Rs. Ps. Fare Date of refund Local Conveyance Amt refunded Daily Allowance Receipt No. Hotel Expenses Hotel Expenses Entertainment Other expenses Total Advance taken on Balance due to Employee Balance due from I hereby certify that the above is true and accurate report of expenditure made by me on behalf of the company. Signature : Name of Employee : Date : Approve by Passed for Rs. /- Mgr/Sr. Mgr (HRM) Approval for special sanction Employee Signature/Controlling Officer ED/Dir (Engg)/CMD For use of Accounts Department For adjustment (Rs) For payment (Rs) Mgr (F&A)/Dy Mgr (F&A)

25 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) Dated : - BILL Sr. No. Particular(s) Amount (Rs.) 1. INCOME : - A. Being the Amount of Professional Fee Due for the Month of B. Being the Amount of Conveyance Reimbursement Due for the Month of DEDUCTIONS : - A Income - Tax for the Month of... Net amount to be paid Rs.. ( Rs. ) Signature :..... Name of Consultant :. Designation :. Controlling Officer :.

26 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. Application for Interest Bearing Advance for purchase of Motor Car / Motor Cycle / Scooter / Moped / Bicycle 1. Name of applicant : 2. Employee Code No. : 3. Designation & Scale of Pay : 4. Pay : 5. Date of appointment : 6. Date of retirement / superannuation : 7. Project / Department : 8. Whether the intention is to purchase a. A New or an Old Motor Car / Motor Cycle / Scooter / Moped / Bicycle : b. If the intention is to purchase a motor car/ motor cycle/scooter/moped/bicycle through a person other than a regular reputed dealer or agent whether previous sanction of the competent authority has been obtained : 9. Do you possess a vehicle? If yes, indicate a. Type of vehicle : b. Date of purchase : 10. Type of vehicle for which advance is required : 11. Anticipated cost of the vehicle : 12. Amount of advance required : 13. Whether advance for the purchase of any conveyance was obtained previously. If so, indicate : a. Date of drawal of advance : b. Whether the amount of advance and/or interest thereon is still outstanding, give details :

27 14. a. Certified that the information given above is complete and true. :2: b. Certified that I have not taken delivery of the motorcar/ motorcycle/ scooter/moped/bicycle on account of which I apply for the advance. That I shall complete negotiations for the purchase and pay finally and take possession of the motorcar/motorcycle/scooter/moped/bicycle before the expiry of one month from the date of drawal of the advance and that the vehicle shall be insured from the date of taking delivery of it. c. Certified that I have read the rules and will abide by them. Signature of Controlling Officer ( Signature of applicant ) Dated: For use of HRM Department The above details and advance applied for have been verified and recommended for Rs.. Personal file D G M ( H R M ) Approving Authority DGM ( HRM ) / ED / Dir (Engg) / CMD For use of F&A Department The advance of Rs. may be released. Manager ( F & A ) / Sr. Mgr ( F & A ) CGM ( F & A ) Receipt Received with thanks from HSCC an amount of Rs. vide cheque No. dated as Conveyance Advance. Dated: Signature of employee

28 1- kh kzd % &,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD.,p,l lh lh fpfdrlk izfriwfrz fu;e HSCC MEDICAL REIMBURSEMENT RULES bu fu;eksa dks,p,l lh lh fpfdrlk izfriwfrz fu;e dgk tk, rfkk ;s fu;e 1 vdvwcj] 2004 ls ykxw gksaxsa 2- dk;z{ks= % & ;s fu;e mu lhkh fu;fer dezpkfj;ksa] izfrfu;qdr dezpkfj;ksa rfkk lafonk dezpkfj;ksa ij ykxw gksaxs tks daiuh ds fu;fer osrueku ij gksaa 3- ifjhkk kk,a % & d- ifjokj ls vfhkizk;% fueufyf[kr ls gs %& (i) ;FkkfLFkfr dezpkjh dh iruh ;k ifr ; (ii) (iii) /kezt larku] lksryh larku rfkk foffkd :Ik ls nrrd larku tks dezpkjh ij iw.kzr% vkfjr gks ; ekrk&firk] ;fn us dezpkjh ij iw.kz :Ik ls vkfjr gksa c krsz fd (d) ekrk&firk dh la;qdr vk; izfrekg 1500@& :Ik;s ( ianzg lks :i;s dsoy ) ls vf/kd u gks ; ([k) os fdlh vu; lzksr ls fpfdrlk ykhk izkir u ys jgs nkok u dj jgs gksaa (iv) fookfgr efgyk dezpkfj;ksa dks bu fu;eksa ds rgr ykhk ysus ds iz;kstukfkz vius ekrk&firk ;k lkl&llqj dks kkfey djus dk fodyi gs] c krsz fd os mdr mi&fu;e (iii) esa fufnz V ik=rk laca/kh ekinam iwjk djrs gksa ; efgyk dezpkjh dh flfkfr esa mlds fookg ds mijkar bl fodyi dk iz;ksx dsoy,d ckj fd;k tk ldrk gsa [k- vi&oftzr dezpkjh ls vfhkizk; gs % & (i) (ii) f izf k{k.k dh vof/k ds nksjku f k{kq rfkk izf k{k.kkfkhz va kdkfyd dezpkjh] nsfud etnwjh ij j[ks x, dezpkjh] vfu;r dezpkjh] vf/kof kzrk dezpkjh rfkk ih-mh- dezpkjha. 2 -

29 - ( 2 ) - (iii) (iv) ijke kznkrk rfkk lykgdkj v/;;ukfkz NqVVh ij x, dezpkjh rfkk NqVVh vof/k ds nksjku muds ifjokja x- izca/k&oxz ls vfhkizk; v/;{k,oa izca/k funs kd vfkok mlds }kjk fo ks k :Ik ls izkf/kd`r fdlh vu; vf/kdkjh ls gs] tks lacaf/kr fu;eksa dks izofrzr djus ds fy, mldh vksj ls dkjzokbz djsxka 4- fpfdrlk mipkj % & fpfdrlk mipkj ls vfhkizk; varjax] cfgjax rfkk fof k V mipkj lfgr fpfdrlk lqj{kk ls gs] blesa dezpkjh vksj mlds ifjokj ds lnl;ksa ls lacaf/kr lhkh vfuok;z fod`fr fokku jksx funku laca/kh] fofdj.k fokku RkFkk vu; fof/k;ka Hkh kkfey gsaa blesa nar mipkj rfkk us= laca/kh mipkj Hkh kkfey gksxka fpfdrlk mipkj ds varxzr fueu mipkj Hkh kkfey gksxk ; d- dezpkjh ;k mlds ifjokj ds fuokl&lfky ( ftlesa x`g&uxj ^^gkse&vkmu** Hkh kkfey gs ) ij ;k dezpkjh ds dk;z&lfky ij fd;k x;k mipkj ; [k- cfgjax jksxh ds :Ik es fd;k x;k mipkj ; x- vlirky esa varjax jksxh ds :Ik esa fd;k x;k mipkja 5- vlirky esa nkf[ky djds fd;k x;k mipkj % & dezpkjh vksj mlds ifjokj }kjk fpfdrlk mipkj dh lqfo/kk Hkkjr esa fdlh Hkh LFkku ij fdlh Hkh vlirky ls izkir dh tk ldrh gs rfkk vlirky esa HkrhZ gksus ds nksjku mipkj ij tks Hkh [kpkz vk;sxk] og oklrfod jkf k ds vuqlkj deiuh ds ^^ esfmdy Q.M VzLV ** }kjk ogu fd;k tk;sxka deiuh dezpkjh ds vuqjks/k ij vlirky izdkjksa dk vfxze :Ik esa tek djsxh ;k tgkwa mfpr gks] vlirky ds fcyksa dk lh/ks Hkqxrku djsxh ;k dezpkjh dh ik=rk ds vuqlkj mudh izfriwfrz djsxha mipkj ij gq;s O;; dh iwfrz ^^,p,l lh lh dezpkjh esfmdy Q.M VzLV ** ls dh tk;sxha vlirky ls NqVVh feyus ds Lke; fufnz V dh xbz nokb;ksa dks gh vlirky esa HkrhZ gksus ds nksjku feys mipkj ds Hkkx :Ik esa ekuk tk;sxka gj izdkj dh Ms&ds;j mipkj dks vlirky esa fn, x, mipkj ds varxzr ekuk tk;sxka. 3 -

30 - ( 3 ) - 6- d{k laca/kh izhkkj % & dezpkjh rfkk mlds ifjokj ds lnl;ksa ds fy;s d{k laca/kh izhkkj le; ij ;Fkk la kksf/kr lj xaxk jke vlirky rd lhfer gksaxsa Js.kh fueu ds rqy; ik=rk ( xaxk jke vlirky ds vuqlkj ) v/;{k,oa izca/k funs funs kd & lqij MhyDl egkizca/kd (bz&6) ls dk;zikyd funs kd (bz&8) & MhyDl dk;zikyd (bz&0) ls mi&egkizca/kd (bz&5) & lkeku; dk;zikyd (bz&0) ls uhps & lk>snkj dejk ( ks;fjax :Ik ) 7- ckg+; mipkj % & dezpkjh rfkk mlds ifjokj ds lnl;kssa ds ckg+; mipkj dh izfriwfrz dezpkjh ds,d ekg ds ewy osru ( 1 vizsy dks ) rd gh dh tk,xh rfkk tks lhkh izdkj ds mipkj ds fy,,d forrh; o kz esa U;wure 9200@& :i;s gksxha gksxha izfriwfrz mi;qdr jlhnksa ds laca/k es vlirky ds funsz fcyksa ij gh Lohdk;Z izfriwfrz ds fy;s fcy funsz k&iphz ( fizfldzi ku ) dh rkjh[k ls rhu ekg ds Hkhrj ^^,p- vkj-,e- ** fohkkx dks Hkst fn;s tkus pkfg,a rhu ekg ls T;knk iqjkus fcyksa ij fopkj ugha fd;k tk,xka 8- nur,pa us= mipkj % & (i) vfgzr nur fpfdrld }kjk nur mipkj ( udyh nkar yxokus lfgr ) djokus ij fd;s x;s O;; dh jkf k dh izfriwfrz oklrfod vk/kkj ij dh tk,xh] tks izfr&o kz ( forrh; o kz ) Rs. 5000@& #Ik;s ( ikap gtkj :i;s dsoy ) rd lhfer gksxha ;g jkf k dezpkjh vksj mlds ifjokj ds lnl;ksa ds ckg+; mipkj ds vfrfjdr gksxha (ii) vfgzr us=&fo ks kk }kjk n`f V dk us= ijh{k.k] ftlesa p esa dh dher Hkh kkfey gksxh] djokus ij gq;s O;; dh jkf k dh izfriwfrz oklrfod vk/kkj ij izfriwfrz dh tk;sxh] tks izfr&o kz ( forrh; o kz ) Rs.2400@& :i;s (pkschl lks #i;s dsoy ) rd lhfer gksxha ;g jkf k dezpkjh vksj mlds ifjokj ds lnl;ksa ds ckg+; mipkj ds vfrfjdr gksxha 9- tkap Vhdk ( Vhdkdj.k ) fdlh Hkh iz;ksx kkyk ls djk;s x;s tkap Vhdkdj.k ls lacaf/kr izhkkjksa dh izfriwfrz ckg+; mipkj lhek ds vykok oklrfod vk/kkj ij dh tk;sxha. 4 -

31 - ( 4 ) jkstejkz fd;s tkus okys mipkj dh izfriwfrz % & dezpkjh rfkk ml ij vkfjr ifjokj ds lnl;ksa ds jkstejkz ds mipkj ds fy;s izfriwfrz dh jkf k fofgr izek.k&i= izlrqr djus ij izfr frekgh Rs.1500@& :i;s ( ianzg lks :i;s dsoy ) vfkkzr Rs.500@& ( ikap lks :i;s ) :i;s izfr ekg rd lhfer gksxha 11- fpfdrlk mipkj ds fy;s vfxze jkf k eatwj djuk % & varjax mipkj dh flfkfr esa dezpkjh ds vuqjks/k ij mls vfxze jkf k iznku dh tk ldrh gsa psd dsoy lacaf/kr vlirky ds uke ij gh tkjh fd;k tk;sxka 12-,XthD;wfVo gsyfk psd&vi ( dk;zikyd LokLF; tkap ) % & dezpkjh deiuh }kjk dh xbz O;oLFkkvksa ds vuqlkj] deiuh }kjk fufnz V vlirky esa esfmdy psd&vi djokus ds ik= gksaxsa esfmdy psdvi dh vkof/kdrk ( fqzdoalh ) fueu :Ik ls gksxh % & vk;q oxz vkorzrk efgyk,a 40 o kz rfkk mlls vf/kd o kz esa,d ckj iq: k 45 o kz rfkk mlls vf/kd o kz esa,d ckj vk;q dh x.kuk izfro kz 1 vizsy dks dh tk;sxha blls lacaf/kr Hkqxrku dk ogu deiuh }kjk fd;k tk;sxka 13- ml fpfdrlk O;; mipkj dh izfriwfrz tgkwa ifr vksj iruh nksuksa vtzd jkstxkj esa gksaa,sls dezpkjh] ftldh ifr lkoztfud {ks= ds midze esa fu;ksftr gks] ds iruh dks vius fu;kssdrk }kjk ;k ^^,p,l lh lh ** }kjk mlds rfkk ml ij vkfjr cppksa ds fy;s fpfdrlk izfriwfrz dk nkok djus dk fodyi gksxka dezpkjh dks vius iruh ds fu;ksdrk }kjk bl vk k; dk,d Ik= izlrqr djuk gksxka 14- jdrk/kku ( CyM VzkaLQ;wt+u ) % & ;fn jdrk/kku djuk vfuok;z gks tk;s rks mlds fy;s jdr&csad ( CyM csad ) dks vnk fd;s x;s oklofod izhkkj dh jlhn izlrqr djus ij izfriwfrz dj nh tk;sxha. 5 -

32 - ( 5 ) lansg dh flfkfr esa ekeys fofufnz V djus dh kfdr % & fpfdrlk mipkj ij fd;s x;s O;; dh izfriwfrz ds fy;s dezpkjh }kjk izlrqr fd;s x;s fpfdrlk nkos ds Lo:Ik vksj folrkj ds laca/k esa lansg mriuuk gksus dh flfkfr esa izca/kd mu nkoksa dks ml eku;rk izkir izkf/kd`r fpfdrlk ifjpkjd] ftls og mi;qdr le>s] dks fofufnz V dj ldrk gsa 16- fu;eksa dk fuozpu % & ;s fu;e ^ vkbz- Mh-,- ( I. D.A. ) * rfkk ^ lh- Mh-,- ( C. D. A. ) * osruekuksa ij deiuh ds lhkh dezpkfj;ksa ij ykxw gksaxsa v/;{k,oa izca/k funs kd],p,l lh lh tc Hkh vko ;d le>s bu fu;eksa dh la kks/ku dj ldsaxsa layxu % & ifjf k V & I ifjf k V & I vlirkyksa dh lwph fueufyf[kr vlirkyksa esa Lo;a rfkk ifjokj ds fy;s varjax vksj cfgzjax mipkj dh lqfo/kk,a miyc/k gsa % & 1- lhkh ljdkjh ljdkj }kjk lgk;rk izkir vlirky 2- LFkkuh; uxj fuxe vkfn }kjk fu;af=r lhkh fmlisaljh 3- ^^ uk ykhk & uk gkfu ** vk/kkj ij LFkkfir psfjvscy VzLV vlirky 4- mldh,tsafl;ksa es jftlvmz lhkh vlirkya

33 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) M~;wVh ij gksus dh lwpuk & iphz On - Duty Information Slip Name : Designation : dezpkjh Employee Number : Date : izlfkku dk Time of Departure : Hkze.k dk Place of visit : Purpose : D;k vkt dk;kzy; okfil vkuk gs \ : ugha Will return back to the office today \ : Yes / No ( Signature ) fu;a=d vuqeksfnr izkf/kdkjh Controlling Officer / Approving Authority Sr. Manager ( H R M )

34 HSCC EMPLOYEES PROVIDENT FUND TRUST Application for Advance from the Fund ( To be completed by the member ) 1. Name of the Member (in block letters) : 2. Employee No. : 3. Father s Name (Or Husband s Name in Case of married Women) : 4. P.F.Account No. : 5. Basic Pay + DA Per Month : 6. Amount of Advance Required (Rs) : 7. Purpose for Which Advance is Required a) Under Rule No.36 ; b) Under Rule No.37 : c) Under Rule No.38 : d) Under Rule No.39 : e) Under Rule No.40 : f) Under Rule No.41 : 8. Whether the advance has been Sanctioned by HSCC for any Purpose mentioned above. If so, the Amount & Date of Sanction thereof 9. Area and Location of Dwelling Site / House intended to be Purchased / Constructed / Already Purchased / Constructed 10. Name & Address of the Present Owner of Dwelling Site / House intended to be Purchased : : : 11. List of Documents to be Enclosed in case of 6(a) & 6(b) i. Title Deed of the proposed Seller / Proof of Ownership ii. Agreement with the vendor for purchase of Site / House iii. Estimate of the cost of construction in case of construction of house iv. Proof of Ownership v. Construction Plan ( Delete items, Which are not applicable) 2/-

35 CONDITIONS : - : 2 : 12. I undertake to comply with the following conditions : i. The amount of advance shall be used for the purpose applied for. ii. If the amount of advance is in excess of the actual expenditure incurred for the purpose for which the advance was granted, the excess amount shall be refunded to the Trust within 30 days of the finalisation of the purchase or completion of construction or the completion of the additions to the dwelling house, as the case may be. iii. If the advance is for the construction of a dwelling house, the construction shall commence within six months of the withdrawal of the first instalment and completed within six months of the final instalment. iv. If the advance is for the purpose of a dwelling unit/site or house, the purchase shall be completed within six months of the withdrawal. v. The amount of advance shall not be utilised for constructing a dwelling site or house which is not free from encumberance and which is a share in a joint family. vi. The amount of advance shall not be utilised for constructing a dwelling house or land, which is not owned solely by me. vii. Such tiltle deeds, plans, other documents and information related to the intended purchases, construction or addition as may be called for by the Trustees from time to time shall be furnished to them on demand. viii. If the purchase or construction for which the advance is granted does not materialise within six months or if there is any breach of the conditions specified herein the entire amount of the advance together with interest thereon at the rate of 6 1/2 percent per annum shall be refunded to the Fund. DECLARATIONS : - I Declare that :- i. I have not taken any advance from the fund mentioned as above. ii. The dwelling site/house intended to be purchase out of the advance applied for is free from encumbrances and is not a share in the joint property. iii. Without the further advance now applied for the construction already commenced cannot be completed/the additions, which are essential, cannot be made. iv. I am the sole owner of the land on which I intend to construct a dwelling house out of the advance applied for. v. All requirements of the local authorities in connection with the intended construction / purchase have been satisfied. ( Delete items not applicable ) Name : Date : ( Signature of Member )

36 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ( Hkkjr ljdkj dk m e ) ( A Government of India Enterprise ) lekpkj i=ksa vksj if=dkvksa ij [kpz fd;s x;s kqyd dh izfriwfrz REIMBURSEMENT OF EXPENSES ON NEWS - PAPERS AND PERIODICALS izekf.kr fd;k tkrk gs Certified that : esaus &&&&&&&& ls &&&&&&&& rd dh vof/k ds nksjku lekpkj i=ksa vksj if=dkvksa dks [kjhnus ij :Ik;s / Rs. ( ) ls de [kpz ugha fd;s gssaa I have spent not less than Rs. /- ( ) during the period from to towards Purchase of Newspapers & Periodicals. Signature : iwjk Full Name : Designation : Date : ( forr,oa ys[kk fohkkx ds To Be Used By F & A Department ) Hkqxrku ds fy, ikl fd;k x;k : : Passed for Payment : Rs. mi izca/kd ( forr,oa ys[kk ) / DM ( F & A ) egkizca/kd ( forr,oa ys[kk ) / GM ( F&A ) ( ACKNOWLEDGEMENT ),p,l lh lh ls mi;qzdr fooj.kkuqlkj Rs. dh /ku jkf k /ku;okn lfgr izkir dha Received with thanks from HSCC a sum of Rs. (Rupees only ) as detailed above. ikus okyk / PAYEE

37 ,p,l lh lh dezpkjh dy;k.k Q.M VªLV H S C C Employees Welfare Fund Trust dezpkjh Employee No ks{kf.kd lacaf/kr lh- Mh- dks [kjhnus gsrq [kpz fd;s x;s kqyd dh izfriwfrz REIMBURSEMENT OF EXPENSES ON PURCHASE OF BOOKs / CDs FOR TECHNICLAL / MANAGERIAL / PROFESSIONAL / EDUCATIONAL PURPOSES izekf.kr fd;k tkrk gs Certified that : esaus &&&&&&&& ls &&&&&&&& rd dh vof/k ds nksjku ks{kf.kd lacaf/kr lh- Mh- dks [kjhnus ij [kpz fd;s x;s kqyd dh izfriwfrz ij :Ik;s / Rs. ( ) ls de [kpz ugha fd;s gssaa I have spent not less than Rs. /- ( ) towards Purchase of Books / CDs For Techniclal / Managerial / Professional / Educational Purposes during the Period from to. Signature : iwjk Full Name : Designation : Date : ( VªLV ds To Be Used By Trust ) Hkqxrku ds fy, ikl fd;k x;k : : Passed for Payment : Rs. lfpo (,p,l lh lh dezpkjh dy;k.k Q.M VªLV ) Secretary ( HSCC Employees Welfare Fund Trust ) v/;{k (,p,l lh lh dezpkjh dy;k.k Q.M VªLV ) Chairman ( HSCC Employees Welfare Fund Trust ) ( ACKNOWLEDGEMENT ),p,l lh lh,p,l lh lh dezpkjh dy;k.k Q.M VªLV ls mi;qzdr fooj.kkuqlkj : psd uecj fnukad jkf k :Ik;s dh /ku jkf k /ku;okn lfgr izkir dha Received with thanks from HSCC Employees Welfare Fund Trust a Cheque No. Dated Amount of Rs. only ) as detailed above. ikus okyk / PAYEE

38 ,p,l lh lh ( bafm;k ) fy- H S C C ( INDIA ) LTD. ( Hkkjr ljdkj dk m e ) ( A Government of India Enterprise ) miflfkfr fuosnu QkeZ ( ATTENDANCE REQUISITION FORM ) Dated : ;g lwfpr fd;k tkrk gs fd esa vkt fnukad dks viuk miflfkfr dkmz vwkfql ykuk Hkqy x;k xbz miflfkfr&ntz e khu esjh miflfkfr ntz djus esa vlefkz jgh] ftlds fy;s eq>s [ksn gsa This is to inform that I, have forgotten to bring the Attendance Card to Office / Attendance Machine failed to read my Finger-Print Today Dated which is sincerely regretted. esa ;g izekf.kr djrh gwwa fd esa lqcg cts vk;k vk;h Fkh vksj lka; cts dk;kzy; ls x;k xbz FkhA I hereby confirm that I reached Office at ( AM ) / left at ( PM ) essjh miflfkfr ntz djus ds fy;s vuqeksnu gsrq izlrqr gsa Approval may please be granted for marking my attendance. Signature : iwjk Full Name : Designation : dezpkjh Employee No. : fohkkx&izeq[k ds glrk{kj H O D s Signature mi&egkizca/kd ( ek- l- iz- dk;zikyd funs kd D G M ( HRM ) / Executive Director

39 H S C C ( INDIA ) LTD. ( A Government of India Enterprise ) *********************** Application for Interest Bearing Advance for Purchase of Motor Car / Motor Cycle / Scooter / Moped / Bicycle 1. Name of Applicant : 2. Employee Code No. : 3. Designation & Scale of Pay : 4. Pay : 5. Date of Appointment : 6. Date of Retirement / Superannuation : 7. Project / Department : 8. Whether the Intention is to Purchase A. A New or An Old Motor Car / Motor Cycle / Scooter / Moped / Bicycle : B. if the intention is to purchase a motor car/ motor cycle/scooter/moped/bicycle through a person other than a regular reputed dealer or agent whether previous sanction of the competent authority has been obtained : 9. Do you possess a vehicle? If yes, indicate a. Type of Vehicle : b. Date of Purchase : 10. Type of vehicle for which advance is Required : 11. Anticipated Cost of the Vehicle : 12. Amount of Advance Required : 13. Whether advance for the purchase of any conveyance was obtained previously. If so, indicate : a. Date of Drawal of Advance : b. Whether the Amount of Advance and/or Interest thereon is still outstanding, give Details :

40 - : 2 : a. Certified that the Information given above is Complete and True. d. Certified that I have not taken delivery of the Motor Car / Motor Cycle / Scooter / Moped / Bicycle on account of which I apply for the advance. That I shall Complete Negotiations for the purchase and pay finally and take possession of the Motorcar / Motorcycle / Scooter / Moped / Bicycle before the Expiry of One Month from the Date of Drawal of the Advance and that the Vehicle shall be Insured from the Date of taking Delivery of it. e. Certified that I have read the Rules and will abide by them. Dated : - ( Signature of Applicant ) For use of HRM Department The above details and advance applied for have been verified and recommended for Rs.. Personal File ( HRM ) DM ( HRM ) CGM ( HRM & Legal ) Approving Authority CGM (HRM & Legal ) / Dir ( Engg ) / CMD For Use of F & A Department The Advance of Rs. may be released. DM ( F & A) / Manager ( F & A ) DGM ( F & A ) Receipt Received with thanks from HSCC an amount of Rs. vide Cheque No. Dated as Conveyance Advance. Dated : - ( Signature of Applicant )

41 ,p,l lh lh ( bafm;k ) fy- ( Hkkjr ljdkj dk m e ) H S C C ( INDIA ) LTD. ( A Government of India Enterprise ),;j cqfdax gsrq fuosnu ( REQUISITION FOR AIR BOOKING ) d`ik;k uhps fn;s x;s fooj.k vuqlkj,;j&cqfdax djus dk d V djsa %& Please arrange to make the following bookings as per details given below :& dezpkjh dk uke / Name of Employee : in / Designation : dezpkjh la[;k / Employee No. : izlfkku,;jiksvz LFkku okgd fviif.k;kwa Departure Airport Place Carrier Remarks fnukad le; ls rd Date Time From To ;k=k vuqeksnu dh izfrfyfi layxu gs / Copy of Tour Approval is Enclosed fohkkx izeq[k ds glrk{kj Signature of the Head of the Deptt. Signature : iwjk Full Name : eksckby Mobile No. : bz&esy E_mail No. : Date : eq[; egkizca/kd ( ekuo lalk/ku izca/ku,oa fof/k ) Chief General Manager ( H. R. M. & Legal )

42 APPLICATION FOR REIMBURSEMENT OF MEMBERSHIP FEE OF RECOGNIZED PROFESSIONAL INSTITUTION 1. Type of Membership : Annual Life 2. Name & Code No : Designation : Department : Area of work/responsibility : Name of the professional institution in which enrolled : Amt of fees (Rs.) Entrance Annual Life Total I hereby certify that the annual membership fee pertains to the same institute as claimed earlier. Certified that I have claimed / not claimed life membership fee for any other Institution. I have claimed/not claimed annual membership fee for other Institution during the current year. * delete which is not applicable Date:... Controlling Officer For use of HRM Department Signature... Recommended for payment of Rs.../- (Rupees......only). CGM (HRM & Legal) For use of F&A Department Dy. Mgr (HRM) Passed for Rs. (Rupees ) DGM (F&A) Receipt Dy Mgr (F&A) Received Rs. from HSCC for above. Date: Signature