Available Format at IHAT

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24

Available Format at IHAT

Name of the Format

DAILY CASH SCROOL
RECEIPT
TRAVEL PLAN / ADVANCE REQUISTION
TRAVEL EXPENSES CLAIM FORM
LOCAL TRAVEL EXPENSES CLAIM FORM
STATEMENT OF EXPENSES
COVERING LETTER
ADVANCE REQUISITION
CONSULTANCY FEE
PURCHASE ORDER
ASSET ISSUE FORM
TRAVEL REIMBURSEMENT FORM (RECRUITMENT)
ASSET REGISTER VEHICLES
ASSET REGISTER LAPTOPS
ASSET REGISTER DESKTOPS
ASSET REGISTER FURNITURE AND OTHRS
TRAVEL CLAIMS FOR TRAINING
PROCUREMENT PLAN
CHECKLIST FOR PROCUREMENT FOR VALUE LESS THAN RS.20,000/-

CHECKLIST FOR PROCUREMENT FOR VALUE RS.20,001/- TO RS.7,50,000/- AND RA

CHECKLIST FOR PROCUREMENT FOR VALUE RS.7,50,000/- TO RS.1,00,00,000/-

COMPARATIVE STATEMENT CUM RECOMMENDATION NOTE FOR VALUE RS.20,001/

COMPARATIVE STATEMENT CUM RECOMMENDATION NOTE FOR VALUE RS.2,00,00

COMPARATIVE STATEMENT CUM RECOMMENDATION NOTE FOR VALUE MORE THA

DAILY CASH SCROLL

INDIA HEALTH ACTION TRUST

UP(TSU) C\O Mr. Ali ,Gayatripuram colony Gird Gonda,Near Modern city Montessory Int
Gonda-271001(UP),Mob.8009903596
Scroll No.

Date

Bank A/c No.

Time

Bank Balance

Rs.

Opening Balance
ADD: Receipts
Total

Less: Payments
Closing Balance
B

Investments / Fixed Deposits

Sl. No.
1
2
3
4
5
6
7

FD No.

Rs.
Date of Deposit

Date of Realization

Totals
C

Cash Balance

Rs.

Opening Balance
ADD: Receipts
Total

Less: Payments
Closing Balance
Cash represented by following Denominations.
Denomination
1,000
500
100
50
20
10
5
2
1
Coins
Total

X
X
X
X
X
X
X
X
X

No's

Amount
-

Prepared by

Verified by

Date:

30-Dec-99

Date:

Note:

Prininting of Cash scroll template Not Required

Single File for one Year.
One Sheet for each working day
Hard copy to be printed every day
Separate file to be maintained for Hard copies on yearly basis

RUST

ern city Montessory Inter college,

596

Rs.

Rs.
Amount

Rs.

CLICK HERE TO GET BACK TO MASTER SHEET

30-Dec-99

RECEIPT

INDIA HEALTH ACTION TRUS

UP-TSU(IHAT)C\O Mr.Izhar Ali,Gayatripuram colony,Gird Gonda,Near Modern c

271001(UP),Mob.8009903596
No.

Date:

Received with thanks from

....
sum of Rs. . (Rupees in words .........
by Cash / Cheque / Draft / Others bearing no.
dated .., drawn on .Payble at.
towards Settlement of Travel Advance / Bill No. / Invoice No. / Others .............
Cheques subject to realization

Prepared by

Received by

Date

Date:

Tally Voucher No.

For Office Use only

Date:

Note:

No. Should start from 0001

First Copy
Second Copy
Third Copy

White
Yellow
Green

Removable
Removable
Fixed

TION TRUST

,Near Modern city Montessory Inter college,Gonda09903596

............................

.........

.............

To Party
To Tally Voucher
With the Book

CLICK HERE TO GET BACK TO MASTER SHE

TRAVEL PLAN / ADVANCE REQUISTION

INDIA HEALTH ACTION TRUST

UP-TSU(IHAT)C\O Mr.Izhar Al, Gayatripuram colony,Gird Gonda,Near Modern CITY Montessory Inter college, Gonda-271001(U
Travel Plan No.

Project

Name

Location
TRAVELLING
Date

From

To

Mode of Travel.
Air/Train/Bus

Night Halt Place & Contact No.

Advance Required for Travel:

Travel Plan Approved by
Advance Required on:

Purpose

Staff / Consultant / Others Signature

& date

Date of Approval

, Gonda-271001(UP),Mob.8009903596
Date:

Purpose of Travel

Travel Expenses Claim Form

INDIA HEALTH ACTION TRUST

UP TSU (IHAT) C/O Mr. Izahar Ali, Gayatripuram Colony, Gird Gonda, Near Modern city montessory Inter

Name
Place of Visit
Purpose of Visit
Location

Samta Jatav
Luckhnow
Nurse mentor training

Date
Time
Food Allowance

Date

1-Aug-14
2-Aug-14
3-Aug-14
4-Aug-14
5-Aug-14
6-Aug-14
7-Aug-14
8-Aug-14
9-Aug-14
10-Aug-14
11-Aug-14
12-Aug-14
13-Aug-14
14-Aug-14
15-Aug-14
16-Aug-14
17-Aug-14
18-Aug-14
19-Aug-14
20-Aug-14

Place of Visit

Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow

Project

UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU

Air/Rail/Bus
Incurred by
Staff

Lodging

Breakfast
(6.00 AM
to 10.00 AM)

Lunch
(12.00 PM to
04.00 PM)

Dinner
(7.00 PM to
12.00 AM)

21-Aug-14
22-Aug-14
23-Aug-14
24-Aug-14

Luckhnow
Luckhnow
Luckhnow
Luckhnow

UP-TSU
UP-TSU
UP-TSU
UP-TSU

25-Aug-14
26-Aug-14
27-Aug-14
28-Aug-14
29-Aug-14
30-Aug-14
31-Aug-14

Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow
Luckhnow

UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU
UP-TSU

Total Incurred by Staff (A)

Abstract

Travel
Travel
Travel
Travel

Ledgers
Expenses-Tickets
Expenses-Accommodation
Expenses-Perdiems
Expenses-Others

UP-TSU

RPC-Strive
-

SHOPS/TB

ILN-Bridge
-

RPC-Strive

Others

MNCH

5,580
-

Air / Rail / Bus Tickets booked by IHAT (B)

Sector

Totals

Staff / Consultant Signature

Date :

Amount

MNCH

Checked & verified by

Date :

ILN-Bridge

m Form
TRUST

ontessory Inter college, Gonda 271001 (UP), Mob. 8009903596

Left on
1-Aug-14

Arrived on

Total No. Day's

Travel
Incidentals

180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180

Local
Conveyance

31
Others

Total

180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180
180

180
180
180
180

180
180
180
180

180
180
180
180
180
180
180

180
180
180
180
180
180
180

5,580
UN Women
-

LWS-

5,580

5,580
5,580
-

Others
-

Final Abstract
Check '0'

Details

Advance Taken
Expenses by Staff (A)
Balance Due to Staff
Expenses by IHAT (B)

Total Expenditure

Approved by
Date :

Amount
5,580
(5,580)
5,580

Local Travel Expenses Claim Form

INDIA HEALTH ACTIO

Uttar Pradesh TSU: No.505 , 5th Floor, Ratan Square No.20 , Vidhan Sabha Marg, Luc
Name

Dr.Shailendra kumar Singh

Location
Sl.
No.
1
2
3
4
5
6
7
8
9
10
11
12

Project
Date

Local Travel
From

To

Purpose of Travel

22
23
24
25

total one hundread seventy ruppes only

Submitted by
3-May-14

Verified by
Date:

l Expenses Claim Form+A26

INDIA HEALTH ACTION TRUST
No.20 , Vidhan Sabha Marg, Lucknow 226001, Uttar Pradesh Ph: 0522 4931777 : FAX-0522 4931778
Date
MNCH
Purpose of Travel

Mode of Travel No. of Kms

Rate

Amount in Rs.

Approved by
Date:

CLICK HERE TO GET BACK TO MASTER SHEET

s.no.

Statement of Expenses
INDIA HEALTH ACTION TRUST
UP-(TSU) C]O Mr.Izhar Ali, Gayatripuram colony ,Gird Gonda,Near Modern city Montessory Inter college,Gonda -271001(UP)Mob.8009903596
Name

Date

Location
Sl. No.

Project
Date

Bill No.

Amount

Item Description

1
2
3
4
5
6
7
8
9
10
11

Total

This is to certify that I have incurred a sum of Rs. ..(Rupees in words

.......) as per the details given above.

Submitted by
Date:

Verified by
Date:

Approved by
Date:

CLICK HERE TO GET BACK TO M

INDIA HEALTH ACTION TRUST

Uttar Pradesh TSU: No.505 , 5th Floor, Ratan Square No.20 , Vidhan Sabha Marg, Luckn
Pradesh Ph: 0522 4931777 : FAX-0522 4931778
Date:

Ref. No.

To,

Dear Madam / Sir

Sub:

Ref:

Please find enclosed herewith the DD / Cheque No. .. Dated .. For Rs.
(Rupees in words ..)
drawn on ....payable at ..in favour of
.towards the following.
Sl. No.

Particulars

Installment / Bill No.

1
2
3
4
5
6
7

Total
Kindly acknowledge the receipt
Thanking you,
for INDIA HEALTH ACTION TRUST

Date

Authorized Signatory

UST

Sabha Marg, Lucknow 226001, Uttar

931778

r of

Date

Amount in Rs.

CLICK HERE TO GET BACK TO MASTER SHEET

Advance Requisition
INDIA HEALTH ACTION TRUST

Uttar Pradesh TSU: No.505 , 5th Floor, Ratan Square No.20 , Vidhan Sabha Marg, Lu
Pradesh Ph: 0522 4931777 : FAX-0522 4931778
Name
Location

Project

Programme Period:
Sl. No.

Due date for Settlement:

Particulars

Total

This is to request you to release an Advance of Rs. ..(Rupees in words

.....) as per the details given above

Submitted by
Date:

Verified by
Date:

Approved by
Date:

RUST

n Sabha Marg, Lucknow 226001, Uttar

2 4931778
Date

Amount in Rs.

etails given above.

by

CLICK HERE TO GET BACK TO MASTER SHEET

CONSULTANCY FEE.
Consultancy Fees for the month/period of:
No.:

Ref. No.:

Date:

Consultany
Letter

Unit:
PAN:

IHAT

Date:
Period From:
Period To:

* From:

To,
HR,
India Health Action Trust
Uttar Pradesh TSU
No. 050, 5th Floor, Ratan Square No. 20,
Vidhan Sabha Marg, Lucknow-226001, Uttar Pradesh
Sl.
No.

Particulars

Grand Total

Period
From

To

Amount per Day /

Month

Signature of the Consultant:

*

Approved by: (Authorised Signator

Date
Photo copy of PAN CARD, Name and residential address is mandatory

CLICK HERE TO GET BACK TO MASTER SHEET

IHAT\HR\CON14\023

unt per Day /

Month

19-Mar-14
19-Mar-14
31-Mar-15

Total Amount in Rs.

ised Signatory of IHAT)

INDIA HEALTH ACTION TRUST

Uttar Pradesh TSU: No.505 , 5th Floor, Ratan Square No.20 , Vidhan Sabha Marg, Lucknow 226001, Uttar Pradesh Ph: 052
Travel Expenses Claim for Project name, Training name, Date from and to
Sl
No.

Name and Designation

Address/contact number

Date of Travel

Bus/train/tempo
From

To

Ticket Cost

10
Total
Total Amount in Words :-

Submitted By

Verified By

Date

Date

ttar Pradesh Ph: 0522 4931777 : FAX-0522 4931778

CLICK HERE TO GET BACK TO MASTER SHEET

e from and to
Local Travel /
Auto

Perdiems

Total Amount

Signature

Approved By
Date

Procurement Plan
INDIA HEALTH ACTION TRUST
Uttar Pradesh TSU: No.505 , 5th Floor, Ratan Square No.20 , Vidhan Sabha Marg, Lucknow 226001, Uttar
Name of the Unit/Branch

Period
Estimated Cost

Sl. No.

Particulars of Goods and Services to be

procured

Name of the project

Unit Description No. of Units

Unit Cost

Cost
-

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Grand Total

Project wise breakup

Sl. No.
1
2

Name of the project

Amount

Sl. No.
6
7

Name of the pr

Grand Total
Prepared by

Date:

Reviewed by Unit Director

Date:

Appendix-01

ACTION TRUST

rg, Lucknow 226001, Uttar Pradesh Ph: 0522 4931777 : FAX-0522 4931778

CLICK HERE TO GET BACK TO MASTER SHEET

Quarterly Breakup
Procurement
Method

Quarter -01 Quarter -02 Quarter -03 Quarter -04

Name of the project

Amount

Grand Total
Approved by Project Director

Date: