Departure and return journey certificate

FORM B Departure and return journey certificate (The Certificate may kindly be filled in, signed and returned to the Secretary, Legislative Assembly, as soon as possible, after completion of the return journey.) 1. Certified that I performed the return journey under section 4 of the Salaries and Allowances of Members of the Legislative Assembly (Puducherry) Act, 1964 leaving ………………………………………………. (place)…………………………………..on the…………….(date)…………………I arrived at……….………..…………………….. (place)………………………….on the …………………..(date). 2. Certified that I have not performed any part of journey (other than the railway journey) by a conveyance provided at the expense of the Government or a Local Fund. *3. Certified that I actually travelled by air from……………….… (place)…………………….………. to ………………………………………. (place) …………….. ………………..by day/night service. Payment of the supplementary bill is required at ……………….. (station) …………………………….. Station: Date: Member of the Legislative Assembly * Strike out if not applicable.