ANNA UNIVERSITY - CHENNAI

OFFICE OF THE CONTROLLER OF EXAMINATIONS

UNIVERSITY EXAMINATIONS - Apr / May || Nov / Dec - ______
CHIEF ANNA UNIVERSITY REPRESENTATIVE CLAIM FORM
Name of the Chief AUR : CAUR CF

Designation : Vr. No.

College Name and Code :

Period of Examination : From .. To. Name of the Zonal Office : Zone XXII, UCEK
Details of Chief Anna University Representative
Name of the Remuneration for
Name of the Institutions & Regn. No. of
Institution Chief AUR Total
Sl. Date of Code Nos. covered for Vehicle Used No. of
(abbreviated) & Code (Rs.700 /- per Amount Signature
No. Exam distribution / collection of on Duty Sessions
No. to which deputed session & (Rs.)
exam materials Provided by ZO
as Chief AUR Rs. 1200 /- per day)

Total:

Grand Total : Rs._______________ Rupees______________________________________________________________________________Only)

Signature with Date

(Affix Revenue Stamp if amount exceeds Rs. 5000 /-)
 Particulars of Savings Bank Account

Kindly furnish the following particulars pertaining to your own savings bank account in order to pay your remuneration
through Electronic Clearing Service (ECS).

Name of the Faculty :

College Code & Name :

Name of the Account :

Account Number :

Name of the Bank & Branch :

IFS Code :

Mobile Number :

Name & Signature of the Faculty with date