Article Reimbursement Form For Publications
(To be submitted to the Research Department)
- Applicant Details
- Name of Applicant: _______________________________
- Designation: _______________________________
- (Faculty/ Students):________________
- Department: _______________________________
- Institution/College: _______________________________
- Employee/Staff ID: _______________________________
- Mobile Number: _______________________________
- Email ID: _______________________________
- Publication Details
- Title of the Article: ___________________________________________
- Authors: ___________________________________________
- Journal Name: ___________________________________________
- ISSN/Indexing: ___________________________________________
- Date of Acceptance: ______________________
- Date of Publication: ______________________
- Publisher Name: __________________________
- Type of Journal: ☐ National ☐ International
- Open Access: ☐ Yes ☐ No
- Scopus/Web of Science/ Pub-med/ UGC Listed: ☐ Yes ☐ No
- Series of Journal: (Q1/Q2/Q3)
- Reimbursement Details
- Total Amount Paid for Publication: ₹ ____________
- Currency (if other than INR): ____________
- Payment Date: ______________________
- Mode of Payment: ☐ Online Transfer ☐ Credit/Debit Card ☐ Other: ________
- Bank Account Details for Reimbursement
- Name of Account Holder: _______________________________
- Bank Name: _______________________________
- Branch: _______________________________
- Account Number: _______________________________
- IFSC Code: _______________________________
- Attachments Checklist (Please tick)
☐ Copy of published article
☐ Payment receipt/proof of transaction
☐ Journal acceptance letter
☐ Copy of journal indexing proof -SJR (SCOPUS/WOS/PUBMED/UGC).
☐ Any other relevant document: _____________________
Declaration by the Applicant
I hereby declare that the details provided above are true to the best of my knowledge and the expenses claimed are not reimbursed from any other source.
Signature of Applicant: _____________________
Date: _____________________
Head of Department Signature: _____________________
For Office Use Only
- Verified by Research: _____________________
- Remark: _________ _
- Amount Sanctioned: ₹ ____________
- Sanctioned By: _____________________
- Date: _____________________
RESEARCH HEAD PRINCIPAL CHIEF OPERATING OFFICER
