microsoft word - form_mentorship_claim - iiserbpr.ac.in  · web viewmentorship cost claim form...

Mentorship Cost Claim Form under DST INSPIRE Scheme(To be filled and submitted by the students)

Name of Student :Program : BS-MS (Dual Degree)Batch :Roll No :Mentorship Cost (Exp.) Claim for the AY :Mentorship Grant Available for current AY: Amount:`SBI Saving Bank a/c no :

Summer Internship DetailsName of the Mentor/ Host InstituteAddress and Contact Details of the Mentor/ Host Institute

Name of the SupervisorDesignation and Department of Supervisor

Tenure / Period of the ProjectProject Title

Total Expenditure Claim (Detailed statement enclosed) Amount `Payment / Reimbursement to be made in thename ofI hereby certify that the details mentioned above are true and correct. Following documents and expenditure bills / receipts are attached herewith in support of claim.

1. Duly attested letter of Research Supervisor and Department Head of the Mentor Institute.2. Expenditure Statement with Original TA claim, Bills and Receipts of expenditure incurred.3. Brief report on objectives and results of the Research Project.

Annex.

I II III

Signature of the Student

Forwarded

HOD

Recommended

DoAA

Approved

Registrar

For the use of F&A office only:

Checked and Passed for Payment : In words `

Assistant/ Jr. Suptd. AR(F&A)/ DR(F&A) Registrar