Certified that:

1. I travelled by the class of accommodation for which travelling allowance has been claimed in the bill.
2. I actually travelled by Mail/Express Train as claimed in the bill.
3. No return ticket was available for the journey for which the claim has been made in the bill.
4. I was actually and not merely constructively present in the camp on the day for which daily allowance has been claimed in the bill.
5. I was not on Casual Leave or Restricted Holidays on the days for which daily allowance has been claimed in the bill.
6. The Govt. Conveyance was not utilised for the journey for which road mileage allowance has been claimed in the bill.
7. I did not perform the road journey for which mileage allowance has been claimed at the higher rate as described in Rules 45 of Supplementary Rules by taking a single seat in any public conveyance which regularly plies for hire between fixed points and charges fixed rate.
8. I also certify that the journey was not performed in any other vehicle without payments of its hire charges for incurring its running expenses.
9. I did not perform road journey along with any other employee of the Sangathan/Govt. servant in a car belonging to him.
10. I was not provided with free boarding or any lodging at the expenses of the Central Govt./State Govt. or Local Body. I did not stay in a Govt. Office.
11. I have not received any TA Advance for the journey for which the claim is prefered.
12. I have eceived an advance of Rs...............................on ....................

1. Certified that the journey was performed in Sangathan's interest.
2. Certified that the claim for personal effects is reasonable.
3. Certified that the journeys for which TA/DA has been claimed in the present bill were actually performed by the officer concerned in the interest of Sangathan.
Dated:
Signature:.......................................