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Application For LTC

1. This document is an application form for availing Leave Travel Concession (LTC) from the Government of India Department of Space Vikram Sarabhai Space Centre. 2. The form requires the applicant to provide personal details like name, designation, basic pay, home town, place to be visited, travel details, family members traveling, and certification that family members are dependent on the applicant. 3. If an LTC advance is being sought, the applicant must undertake to produce tickets within 10 days and refund the entire advance with interest in case of cancellation or failure to submit tickets on time.

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AKRISHNAMURTY,HEADMASTER,ZPHS(G),DOWLESWARAM
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225 views

Application For LTC

1. This document is an application form for availing Leave Travel Concession (LTC) from the Government of India Department of Space Vikram Sarabhai Space Centre. 2. The form requires the applicant to provide personal details like name, designation, basic pay, home town, place to be visited, travel details, family members traveling, and certification that family members are dependent on the applicant. 3. If an LTC advance is being sought, the applicant must undertake to produce tickets within 10 days and refund the entire advance with interest in case of cancellation or failure to submit tickets on time.

Uploaded by

AKRISHNAMURTY,HEADMASTER,ZPHS(G),DOWLESWARAM
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Government of India

Department of Space
VIKRAM SARABHAI SPACE CENTRE
Thiruvananthapuram – 695-022

APPLICATION FOR AVAILING LTC

1. Name SC.No. Designation Division/Project

2. Nature of Leave granted No. of Days From To

3. Whether Permanent or Temporary : Permanent/Temporary *

4. Present Basic Pay + SI + NPA :

5. Home Town as declared and recorded


in the Service Book :

6. Place to be visited :

7. Nearest Railway Station :

8. Whether Home Town or Any Place in India :

9. Block Year :

10. Mode of journey & Class of Journey :

11. Train &Train No. :

12. Proposed date of outward journey :

13. Proposed date of return journey :

14. Whether LTC advance is required : Yes/No

15. State whether LTC advance has been


drawn earlier for the same block year : Yes/No

16. Persons in respect of whom LTC is proposed


To be availed including Govt. servant :

Sl.No. Name Relationship Age/Date Employment Monthly


with employee of birth@ Status Income$

@ In case of Children & minor brothers, state date of birth


$ Income includes gross pension and relief thereon
17. Whether spouse is employed or not : Yes/No

18. If employed, Office/Organisation where


Spouse is employed (give full address) :

19. If employed, state whether spouse is eligible


for LTC from her/his employer (Attach a certificate
to that effect /Joint declaration as the case may be) :

20. State whether any of the family members


for whom the LTC applied now are residing
at a place other than Head Quarters, if Yes
furnish the details :

CERTIFICATE

Certified that my family members (except spouse) for whom LTC advance is applied
for are residing with me at Head quarters/residing at Home Town/studying at other
places and wholly dependent upon me and their individual income is below Rs.1500/-
p.m.

I declare that the particulars furnished above are true and correct to the best of
my knowledge. I undertake to produce the ticket within 10 days of receipt of the
advance.

In the event of cancellation of the journey or if I fail to produce the tickets


within 10 days of receipt of advance I undertake to refund the entire advance in
one lumpsum, with penal interest.

Signature :
Name :
Date : Telephone No :
(Recommendation of the Controlling Officer)

LTC is approved subject to eligibility. Advance applied for by


----------------------------may be granted subject to Rules.
Signature :
Name :
Designation :
Division/Project :
Date: ( Seal to be affixed)
PS: Strike out which ever is not applicable. All columns are to be filled up
properly and completely.
• If LTC advance is required, application should reach Establishment
Section well in advance at least 10 working days for processing the
same.
• In case of temporary Govt. servant a surety bond obtained from a
permanent Govt. servant, in the prescribed format is to be enclosed.

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