FORM NO: ANNEXURE AREIMBURSEMENT OF STICHING CHARGES

HQ/DIVISION :______________________ BILL UNIT NO.___________PF NO. _________________

1.NAME OF EMPLOYEE

2.DESIGNATION

3.DEPARTMENT

4.SCALE OF PAY & RATE OF

5.DATE OF APPOINTMENT

6.DATE OF SUPERANNUATION

7.DATE OF RECEIPT OF UNSTITCHED CLOTH

8.TYPE OF CLOTHES STITCHED

SEASONTYPE/STYLE OF GARMENT DATE OF ISSUE OF CLOTHDATE OF SUBMISSION VERIFICATION OF STITCHED UNIFORMS NO. OF PIECES RATE

SUMMER03/03/12

WINTER

TOTAL

9.TOTAL AMOUNT TO BE REIMBURSED

Amount in words:

It is certify that employee has produced stitched garment of summer/winter as per prescribed style and entry to that effect has been made by me at Sr. No. ____________ of the register. It if further certified that stitching charges for this season has not been certified earlier for reimbursement.

(Signature of controlling officer)(Signature of Sr. Subordinate In charge) NAME : _________________________________DESIGN.: ______________________DESIGN.: _________________________________DATE : ________________________DEPTT.: _________________________________DATE :_________________________________