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LTC & LTC Advane Form (1)

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deepak.lade1995
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69 views4 pages

LTC & LTC Advane Form (1)

Uploaded by

deepak.lade1995
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application for Grant of Leave Travel Concession (L.T.C.) / L.T.C.

Advance
1. Name of the Government Servant
2. Designation
3. Employee Code No.
4. Telephone No.
5. Email address
Date of entering in the Central Government
6.
Service
7. Pay (Matrix & Basic Pay)
8. Whether Permanent or Temporary
a) Home Town as Recorded in Service Book
9.
b) Nearest Railway Station
Whether wife / husband is employed & if
10. YES / NO
so whether entitled to L.T.C.
Whether the concession is to be availed for YES / NO
11. visiting home town, and Block Year if so
Block Year for which L.T.C. is to be availed Block Year………….
If the concession is to visit Anywhere in
12. India, name the place to be visited and
Block Year for which L.T.C. is to be availed.

Nature of Leave & Period(Enclose copy of


Leave sanction order)
OR
13. (Applicable in case of advance / LTC required for family members only)

Proposed date for onward journey

Proposed date of return journey

Single Rail / Bus Fare: from the


14. Headquarter to Home Town / Place of visit
by shortest route.
15. Persons in respect of whom L.T.C. is proposed to be availed
S.No. Name Age Relationship

Yes/No
16. Advance required , if so required Amount
Amount Rs…
i) I declare that the particulars furnished above are true and correct to the best of
my knowledge, I undertake produce the tickets for the outward journey within
ten days of receipt of advance. In the event of cancellation of the journey or if I
fail to produce the tickets within 10 days of the receipt of the advance, I undertake
to refund the entire advance in one lump sum.
17.

ii) That my husband/wife is not employed in govt. service/that my husband/wife is


employed in govt. service and the concession has not been availed of by
himself/herself or for any of the family member for the concerned block of
……………………..years.

Date:
Signature of the Applicant
Place:
(Name of the Applicant)
Proforma for self-certification by the Government employee

I, ........................................................................(Name of the Govt. servant &


Post ) wish to confirm that I am availing ................... (Home Town/ Any Place in India)
LTC in respect of self / family member(s) for the block year 2018-21 to Visit
................... (Place of visit) during ................ (outward journey) (dates of journey). It is
stated that I or the family member for whom I wish to avail LTC has/have not availed
of the same before in the present block.

2. Particulars of members of family in respect of whom the Leave Travel Concession


is being claimed are as under:
S.No. Name Age Relationship with the
Government servant
1.
2.
3.
4.
5.
6.
7.

3. It is certified that the above facts are true and any false statement shall make
me liable for appropriate action under Rule 16 of CCS (LTC) Rules, 1988 and the
relevant disciplinary rules.

(Signature of Govt. servant)

Name:____________________________

Designation:____________________________

Contact No.:____________________________

Date: ____________________________

* N.B.: Government employee may share interesting insights and pictures, if any, of
the destination visited while availing LTC on an appropriate forum.
CHECK LIST (Cash and Accounts Section)

1. Amount entitled for : Fare Rs. ......X 2 X (No. of tickets) Reimbursement

2. Advance admissible ( 90% of the amount i.e. Rs. ...........)

Advance of Rs. ...............................................


may be sanctioned.

Dealing Hand. Signature of D.D.O.

=========================================================================

CHECK LIST FOR ADMINISTRATION

L.T.C. advance to __________________________________________________


1. Block Year / Calendar Year :

2. Home Town / A place anywhere in India :

3. a) For whom advance is applied for :


b) Total number of persons :

4. Specific grounds waranting sanction : for both/ onwards/ return journey of


advance under Rule G.F. 235 (2) (iii) (a)

5. Leave application received : Yes / No


Amount of
6. advance : Rs.
7. Temporary / Permanent :
8. If temporary (Surety bond produced) : Yes / No
Necessary entry has been
made in the L.T.C. Advance Register.
He/She is eligible for L.T.C. for the Block/Calender Year ...............

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