CENTRAL UNIVERSITY OF KASHMIR
CLAIM FORM FOR REIMBURSEMENT OF TELEPHONE (FL)/MOBILE/BROADBAND CHARGES
(Claims to be preferred by or before 10th of every month)
Name of the claimant Designation
Department Employee ID
Bank Details Account Number Bank &Branch IFSC Code MICR Code SBI BBCANTT
To
The Finance Officer/Registrar, Central University of Kashmir.
Kindly arrange to reimburse Telephone charges of Rs. - for the month of ___, details of which are given below. The amount may be credited to my Bank account stated above:
LANDLINE NUMBER: MOBILE NUMBER:
Month/Period Billed amount Total amount
paid
Amount eligible for reimbursement Landline Mobile
Total Telephone charges (A) Broadband charges:
Month/Period Rentals Usage charges Total amount paid
Amount eligible for reimbursement
- - Total Broad Band charges (B)
Grand Total (A+B) Endorsements:
1. Certified that I have not been provided with Centrex line at my Residence
2. Certified that above telephones are on my name /that I am the bonified user of these telephones.
3. Certified that I have incurred the above expenditure towards telephone, broadband charges etc during the period mentioned above.
4. Certified that the calls during above period were made for discharging official duties and were in the public interest
5. Certified that the bills do not include ISD calls
6. Certified that my maximum telephone re-imbursement limit is INRas approved by the University vide order No. ____________________________________________(copy appended)
7. Certified that the bills in original along-with payment receipts are enclosed for processing re- imbursement.
Signature of the Claimant
Place: SRINAGAR Dated: ___________
