Ltc Claim Proforma For Central Government Employees 6b204h
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Sub Bill No……………………….
T.R.25.C
Leave Travel Concession Bill for the block of year __________ to _________ PART-A[To be filled up by Government Servant] 1. Name _________________________ 2. Designation __________________________ 3. Pay ___________________________ 4. Headquarters _________________________ 5. Nature and period of leave sanctioned, from ______________ to __________________ 6. Particulars of of family in respect of whom the LTC has been claimed. Sl.No Name Age Relationship with the Govt. Servant 1 2 3 4 5 6 7. Details of journey(s) performed by Govt. servant Departure Arrival Distance In KMs Date & From Date & To time time
and the of his/her/family Mode of No. of Fare Remarks Travel & fares Paid class of Rs. accommodation used
8. Amount of advance if any drawn Rs. _________________ 9. Particulars of journey(s) for which higher class of accommodation than the one to which the Govt. servant is entitled, was used(Sanction number and date to be given) Place Mode of Class to Class by No. of Fare paid conveyance which which actually fares Rs. From To entitled travelled
..Contd.,
10. Particulars of journey(s) performed by road between places connected by rail : Name of places Class to which entitled Fare Rs. From To
Certified that the 1. Information as given above is true to the best of my knowledge and belief, and 2. that my husband/wife is not employed in government service/that my husband/wife is employed in government service and the concession has not been availed of by him/her separately or himself/herself or for any of the family or the concerned block of __________ years. Signature of the Government Servant Date : PART B[To be filled in the Bill Section] 1. The net entitlement on of leave travel concession works out to Rs.________ as detailed below : (a) Railway/Air/Bus/Steamer fare Rs. ___________ (b) Less amount of advance drawn vide Voucher No. _____________ dtd _____ Rs. ______ (c) Net amount Rs.________ (Rupees__________________________________________) 2. The expenditure is debitable to _______________ Signature of Bill Clerk
Signature of DDO Countersigned Signature of controlling office
Certified that necessary entries have been made in SB of Sri/Smt./Miss ________________ Signature of the officer authorised to
T.R.25.C
Leave Travel Concession Bill for the block of year __________ to _________ PART-A[To be filled up by Government Servant] 1. Name _________________________ 2. Designation __________________________ 3. Pay ___________________________ 4. Headquarters _________________________ 5. Nature and period of leave sanctioned, from ______________ to __________________ 6. Particulars of of family in respect of whom the LTC has been claimed. Sl.No Name Age Relationship with the Govt. Servant 1 2 3 4 5 6 7. Details of journey(s) performed by Govt. servant Departure Arrival Distance In KMs Date & From Date & To time time
and the of his/her/family Mode of No. of Fare Remarks Travel & fares Paid class of Rs. accommodation used
8. Amount of advance if any drawn Rs. _________________ 9. Particulars of journey(s) for which higher class of accommodation than the one to which the Govt. servant is entitled, was used(Sanction number and date to be given) Place Mode of Class to Class by No. of Fare paid conveyance which which actually fares Rs. From To entitled travelled
..Contd.,
10. Particulars of journey(s) performed by road between places connected by rail : Name of places Class to which entitled Fare Rs. From To
Certified that the 1. Information as given above is true to the best of my knowledge and belief, and 2. that my husband/wife is not employed in government service/that my husband/wife is employed in government service and the concession has not been availed of by him/her separately or himself/herself or for any of the family or the concerned block of __________ years. Signature of the Government Servant Date : PART B[To be filled in the Bill Section] 1. The net entitlement on of leave travel concession works out to Rs.________ as detailed below : (a) Railway/Air/Bus/Steamer fare Rs. ___________ (b) Less amount of advance drawn vide Voucher No. _____________ dtd _____ Rs. ______ (c) Net amount Rs.________ (Rupees__________________________________________) 2. The expenditure is debitable to _______________ Signature of Bill Clerk
Signature of DDO Countersigned Signature of controlling office
Certified that necessary entries have been made in SB of Sri/Smt./Miss ________________ Signature of the officer authorised to
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