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Annexure-A: Application For Availing of Leave Travel Concession

This document contains an application for leave travel concession (LTC) along with supporting annexures. [1] The application includes details of the employee such as name, designation, date of appointment, period for which LTC is proposed, and family members for whom LTC is being availed. [2] Annexure B requires the employee to certify that they have not claimed LTC for the same period previously and provides checkboxes to select the appropriate scenario. [3] Annexure C is an affidavit where the employee affirms that the journeys claimed in the LTC bill were actually performed.

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607 views

Annexure-A: Application For Availing of Leave Travel Concession

This document contains an application for leave travel concession (LTC) along with supporting annexures. [1] The application includes details of the employee such as name, designation, date of appointment, period for which LTC is proposed, and family members for whom LTC is being availed. [2] Annexure B requires the employee to certify that they have not claimed LTC for the same period previously and provides checkboxes to select the appropriate scenario. [3] Annexure C is an affidavit where the employee affirms that the journeys claimed in the LTC bill were actually performed.

Uploaded by

Xen Operation DPH
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as XLS, PDF, TXT or read online on Scribd
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ANNEXURE-A

APPLICATION FOR AVAILING OF LEAVE TRAVEL CONCESSION


1.
NAME
     …………….
OF THE OFFICER/EMPLOYEE
POST
2.      HELD ……………..
DATE
3.      OF APPOINTMENT IN PRESENT SERVICE
PERIOD DURING WHICH LTC IS PROPOSED TO BE AVAILED
OF(IN
4.    CASE OF SELF PLEASE INDICATE WHETHER LEAVE
HAS BEEN SANCTIONED
BLOCK OF THE YEAR FOR WHICH L.T.C.IS PROPOSED TO BE
5.     
AVAILED OF
DETAILS
### OF L.T.C. BE TO AVAILED OF:
(i) WHETHER FOR VISITING IN HOME TOWN
(ii) WHETHER FOR VISITING ANYOTHER PLACE IN INDIA

(iii) IN CASE OF (b) OF THE ABOVE THE PLACE TO BE VISITED


###       MEMBERS OF FAMILY FOR WHICH L.T.C.IS AVAILED
S.NO. NAME OF FAMILY MEMBER RELATION WITH EMPLOYEE

WHEN THE L.T.C. WAS AVAILED OF LAST(INDICATE THE


8.(a) BLOCK YEAR FOR WHICH L.T.C. AVAILED OF & THE PERIOD
DURING WHICH IT WAS AVAILED OF)

(b) IF ANY SANCTION FOR THE GRANT OF L.T.C. WAS


ISSUED,PLEASE QUOTE NO. & DATE
IT IS CERTIFIED THAT LEAVE TRAVEL CONCESSION FOR THE BLOCK YEARS BEING CLAIMED ABOVE WAS NOT
AVAILED OF PREVIOUSLY.
IT IS FURTHER CERTIFIED THAT THE MEMBERS OF FAMILY FOR WHOM L.T.C. IS BEING CLAIMED,ARE RESIDING
WITH ME.

DATED. SIGNATURE OF APPLICANT

PLACE.
DESIGNATION
ANNEXURE -B
CERTIFICATE TO BE GIVEN BY GOVT. EMPLOYEE
1 I HAVE NOT SUBMITTED ANY OTHER CLAIM SO FOR FOR L.T.C. IN RESPECT OF MYSELF OR MY FAMILY
MEMBERS IN RESPECT OF BLOCK OF TWO/FOUR YEARS FROM TO
2 I HAVE ALREADY DRAWN T.A. FOR THE L.T.C. IN RESPECT OF A JOURNEY PERFORMED BY ME/MY WIFE
WITH CHILDREN.THE CLAIM IS IN RESPECT OF THE JOURNEY PERFORMED BY MY WIFE
/MESELF WITH CHILDREN/ CHILDREN NONE OF WHOM TRAVELLED WITH
THE PARTY ON EARLIER OCCASSIONS.
3 I HAVE NOT ALREADY DRAWN T.A. FOR THE L.T.C. IN RESPECT OF A JOURNEY PERFORMED BY ME/
MY WIFE WITH CHILDREN/ CHILDREN IN RESPECT OF THE BLOCK OF
TWO/FOUR YEARS FROM AND THE CLAIM IS IN RESPECT OF
CHILDREN NONE OF WHOM AVAILED OF THE CONCESSION RELATED TO THAT BLOCK.
4 I HAVE ALREADY DRAWN T.A. FOR THE L.T.C. IN RESPECT OF A JOURNEY PERFORMED BY ME IN THE
YEAR IN RESPECT OF BLOCK OF TWO/FOUR YEARS FROM AND
.THIS CLAIM IS IN RESPECT OF JOURNEY PERFORMED BY ME IN THE YEAR
.THIS IS AGAINST THE CONCESSION ADMISSIBLE ONCE EVERY TWO YEARS IN A PRESCRIBED BLOCK FOR
VISITING HOME-TOWN AS ALL THE MEMBERS OF MY FAMILY ARE LIVING AWAY FROM MY PLACE OF
WORK.
5
THE JOURNEY HAS BEEN PERFORMED BY ME/MY WIFE WITH CHILDREN/
CHILDREN TO THE DECLARED HOME-TOWN/VILLAGE/PLACE
IN INDIA.
THAT MY HUSBAND IS NOT EMPLOYED/THAT MY HUSBAND IS EMPLOYED IN GOVT. SERVICE & THE
6 CONCESSION HAS NOT BEEN AVAILED OF BY HIM /HER SEPARATELY FOR HIMSELF/HERSELF IOR ANY
FAMILY MEMBER IN CONCERNED BLOCK OF TWO YEARS/FOUR YEARS.

SIGNATURE OF GOVT. EMPLOYEE


ANNEXURE-C
AFFIDAVIT
I S/D OF EMPLOYED AS
IN THE OFFICE OF DO HEREBY SOLEMNLY
AFFIRM & DECLARE THAT JOURNEYS IN RESPECT OF WHICH L.T.C. FOR VISITING
IS BEING CLAIMED VIDE MY BILL FOR THE PERIOD WERE ACTUALLY PERFORMED BY
ME AND/OR MEMBERS OF MY FAMILY AS PER DETAILS GIVEN IN THE L.T.C. BILL.

DEPONENT
VARIFICATION
VARIFIED THAT THE ABOVE FACTS ARE TRUE TO THE BEST OF MY KNOWLEDGE & BELIEF & THAT NOTHING HAS BEEN
CONCEALED THEREIN.

DATE
PLACE DEPONENT

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