ASDP Basket Fund - Ministry Of Agriculture, Food and Cooperatives

ANNEXURE “27.C”The United Republic of TanzaniaAPPLICATION FOR ISSUE OF SAFARI IMPRESTRef. No. ………………………………………………A. To be completed by the Applicant (in duplicate)1. Name as per payroll…………………………………………………………………2. Designation ………………………….3. Department ……………………………4. Check Number ………………………5. Salary Scale ………………………….6. Subsistence Allowance Rate p.n. ………………………………………………7. Details of Safari:a. Date Leaving Station ……….b. Date Returning Station ………………c. Places to be visited (with dates)………………………………………….d. Purpose of Safari …………………………………………………………8. Details of Imprest Required:a. Subsistence allowance for…………..…night @ Shs. ……………….per night…………………………………………. Shs. ………………..b. Incidental Expenses: i. Taxi Fare………….. Shs. ………………..ii. Bus/Train/Air Fare….. Shs. ………………..iii. Airport Charge……… Shs. ………………..iv. Other Expenses Shs. ………………..(give details)Total Shs. ………………..9. Details in respect of Safari outside Tanzania:a. State House Authority No. ………………….of ………………………….b. Exchange Control Authority (where already given) No. ………………of………………………….c. Is the safari assisted by any government/donor and if so give details…………………………………………………………………………………10. Total number of nights on safari during the current year excluding this ……I hereby certify that the particulars given above are correct to the best ofmy knowledge and that I have no previous imprest outstanding.Date…………………………Signature………………………………(Applicant)B. To be completed by Accountant-in-charge, Cash Office:1. The above officer has no outstanding imprest/has an outstanding imprestDate……………………….Signature………………………………..(Accountant)C. To be completed by the Head of the DivisionThe above safari has been authorised by me and a safari imprest of Shs……is recommended.Please authorise Bus/Train/Air warrant from ……..……to……..……..and back.Date……………………….D. Approval by Accounting Officer:Signature………………………………..(Head of the Division)1. The imprest of Shs. ……………………………….is approved/not approved.2. This imprest must be retired before………..failing to which the officer will beliable to a surcharge of 10% of the unretired amount monthly until the wholeimprest is retired fully.3. Unspent balance (if any) must be refunded in cash or in foreign exchangeas the case may be.Date…………………………… Signature………………………………..(Accounting Officer)For cash office Use Only:Imprest No. …………….. P.V. No. …….…….. Amount Paid ………………….Copy to: Warrant Holder - for commitment entry in the vote book.B 17