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LTC Advance Form

The document is an application form for a government employee to request a Long Term Care (LTC) advance, which requires the applicant to provide their personal details like name, designation, home town, family information, the purpose and destination of travel, and a list of family members traveling. The applicant must declare that the information is true and agree to produce tickets within 10 days of receiving the advance or refund the entire amount if the trip is cancelled.

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karan
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
258 views

LTC Advance Form

The document is an application form for a government employee to request a Long Term Care (LTC) advance, which requires the applicant to provide their personal details like name, designation, home town, family information, the purpose and destination of travel, and a list of family members traveling. The applicant must declare that the information is true and agree to produce tickets within 10 days of receiving the advance or refund the entire amount if the trip is cancelled.

Uploaded by

karan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Application form for grant of LTC advance

1. Name of the Government Servant

2. Designation
Date of entering the Central Government
3.
Service

4. PAY + SI + NPA

5. Whether permanent or temporary


6. Home Town as recorded in the Service Book
Whether wife / husband is employed and if
7.
so whether entitled to LTC
Whether the concession is to be availed for

8. visiting home town and if so block for which


LTC is to be availed.
(a) If the concession is to visit anywhere in

9. India, the place to be visited.


(b) Block for which to be availed.
Single rail fare/bus fare from the

10. headquarters to home town/place of visit by


shortest route.
Persons in respect of whom LTC is proposed to be availed.
S.No Name Age Relationship
1.
2.
11. 3.
4.
5.
6.
Amount of advance required. Rs.
12.

I declare that the particulars furnished above are true and correct to the best of my knowledge. I
undertake to produce the tickets for the outward journey within ten days of receipt of the advance.

In the event of cancellation of the journey or if I fail to produce the tickets within ten days of receipt of
advance, I undertake to refund the entire advance in one lump sum.

Date
Signature of Government Servant.

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