,

,
Government of India
Geological Survey of India,
Central Region,
.. . , , -6/ GSI New Complex, Seminary Hills, Nagpur-440006.

:
/,
.............................................. ..........

The receipt of letter No....................................................
dated..................... on the subject mentioned above is acknowledged with thanks.

/
Yours faithfully

,
,

Government of India
Geological Survey of India,
Central Region,
.. . , , -6/ GSI New Complex, Seminary Hills, Nagpur-440006.

:
/,
// ---------------------------------------

The application received from

Shri / Smt. /Ku. -------------------------------------on the above mentioned subject is enclosed herewith for
further necessary action.

/
Yours faithfully

izi= 1
ns[ks fu;e 14
1-

Nqh ;k Nqh c<kus ds fy, vkosnu

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%
Name of applicant

2-

in
Post held

3-

foHkkx] dk;kZy; rFkk

izHkkx@vuqHkkx

Department, office and Division/ Section

4-

osru ewy
Pay (basic)

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rFkk vU; izfriwjd Hkks
House rent allowance or other compensatory allowance
drawn in the present post.
Nqh dh fdLe] rFkk vof/k ,oa mlds
'kq# gksus dh frfFk
%
Nature of leave & period & date of starting which required
'kfuokj] jfookj vkSj Nqh ds fnu] ;fn dksbZ gks]
ftUgsa Nqh ls igys rFkk ckn esa tksMuk
pkgrs gSA
%
Saturday, Sunday and holidays, if any, proposed to be
prefixed/suffixed to leave.
Nqh dk dkj.k

67-

8-

Ground of leave
9-

fiNyh Nqh ls ykSVus dh frfFk

vkSj ml Nqh dh fdLe rFkk vof/k
%
Date of return from last leave and the nature and period of that leave.

10.

esjk bjknk vkxkeh Nqh ds nkSjku

-------------------------------------------------- ds [k.M
o"kksZa ds fy, Nqh ;k=k fj;k;r ysus dk gSS@ugh gS A
%
I propose/ do not propose to avail myself of leave travel concession
for the block yearsDuring the ensuing leave.
11-

Nqh dh vof/k ds nkSjku i=kpkj dk irk

Address of correspondence during leave period

fnukad
@date ____
applicant
LFkku@Place__________

vkosnd ds gLrk{kj@ Signature of the

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fnukad@date __________
gLrk{kj@ signature _______________________

14- Nqh Lohd`fr dk l{ke

izkf/kdkjh dk vkns'k

Order of the authority competent

to grant leave

fnukad @date __________

gLrk{kj@ signature _______________________

--------------------------------------------------------------------------------------------------------------------

*;fn vkosnd dksbZ izfriwjd Hkkk ys jgk gS] rks ;g Nqh dh lekfIr ij
vkns'kksaa esa Hkh lwfpr fd;k tkuk pkfg,] ljdkjh lsod leku Hkks dks
ysrs gq, laHkor% mlh in vFkok vU; in ij cus jgsaxsA
* If the application is drawing any compensatory allowance, it should also be indicated
in the orders on the expiry of leave, the Government servant is likely to return to the
same post or another post carrying similar allowance.


(.)

lkekU; Hkfo"; fuf/k esa ls vfxze ysus gsrq izkFkZuk i= A

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10- vLFkk;h fudklh ds izkFkZuk i= dk vkSfpR; crkrs gq,
vaknkrk dh vkfFkZd ifjfLFkfr;ksa dk iw.kZ fooj.k
%----------------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------eS ;g izekf.kr djrk gwa fd mij fn;k x;k fooj.k esjh tkudkjh
rFkk fookl ds vuqlkj lgh ,oa iw.kZ gS rFkk esjs }kjk dqN
ugha Nqik;k x;k gS A
ukxiqj
fnukad %
gLrk{kj

vkosnd ds

GOVT. OF INDIA
GEOLOGICAL SURVEY OF INDIA (CR)
APPICATION FOR ADVANCE FROM G.P. FUND
1.Name of the dubscriber
:_________________________________________________
2.Account No.

:-

_________________________________________________
3.Designation

:-

_________________________________________________
4.Pay

:-

Rs.______________________________________________
5.Balance at credit of the subscriber on the date of application as below :i)

Closing Balance as per Statement for the year_______Rs.

ii)

Credit from___________To____________@Rs.__________Rs.__________
Credit from___________To____________@Rs.__________Rs.__________
Credit from___________To____________@Rs.__________Rs.__________
Credit from___________To____________@Rs.__________Rs.__________

iii)

Refund of Advance :-

from___________To____________@Rs.__________Rs.__________
from___________To____________@Rs.__________Rs.__________
from___________To____________@Rs.__________Rs.__________
from___________To____________@Rs.__________Rs.__________
Total Rs.__________
iv)

Withdrwals/ advance during the period

from___________To_____________

Rs.__________

v)

Net Balance at credit :-

Rs.__________

6.

Amount of Advance / advance outstanding :Amount of Advance Taken on date of sanction.

Balance outstanding as on date
Rs.____________________________
Rs.________________________

7.

Amount of Advance required

Rs.________________________

8.

(a)Purpose for which the advance is required

________________________________
(b)Rules under which the request is coverd
________________________________
(c) If advance is sought for House building etc. following information may be

given.
(i)

Location and measurement of plot

________________________________
(ii)

Whter plot is free hold on lease

________________________________
(iii)

Plan for construction

________________________________
(iv)

If the flat or plot being purchased

from a. H.B. socity, the name of the
society, the location and mesurement
etc._____________________________
v)
Cost of construction
________________________________
vi)

If the purchase of flat in from DD or

housing board etc. may be given.
________________________________
Contd........2....
........2........
(d) If the advance is required for education
of children, following details may be
given.________________________________
i)
Name of the Son/Daughter
________________________________
ii)
Class-Institution/College
________________________________
iii)
Whether a day scholar or a hostler
________________________________

(e)

If advance is required for treatment of ailing family member, following

details
may be given :(i)
Name of the Patient
________________________________
(ii)
Name of the Hospital, Dispensary,
Doctor where the patient is
undergoing treatment
________________________________
(iii)
Whether outdoor/indoor Patient
________________________________
(iv)
Whether reimbursement available
or not
________________________________
Note :- In case of advance 8 (c) to 8 (e), a certificate of docucumentary evidence would
be required.
9.
i)
Amount of the consolidated advance (item 6 to 7)
Rs.__________________
ii)
Number of the monthly instalments in which the
consolidated advance is proposed to be
repaid________________@Rs.___________
10.

Full particulars of the pecuniary

________________________________
circumstances for the subscriber
________________________________
justifying the application for the
________________________________
advance.
________________________________

I certify that particulars given above are correct and complete to the best
of my knowledge and belif and that noting has been concealed by me.

NAGPUR.
Date : ______________20

Signature of applicant

Hkkjr ljdkj
Hkkjrh; HkwoSKkfud losZ{k.ke/; {ks=
lkekU; Hkfo"; fuf/k ls fudklh gsrq vkosnu
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%----------------------------------------------------2- ys[kk la%----------------------------------------------------3- inuke
%----------------------------------------------------4- osru
%----------------------------------------------------5- dk;Zxzg.k djus dh frfFk rFkk
lsokfuo`fRr dh frfFk
%----------------------------------------------------6- vkosnu dh frfFk ij va'knkrk dk cdk;k tek uhps fn, vuqlkj %
i ----------------o"kZ esa lk-Hk-fu-ds fooj.kh ds vuqlkj
varks"k %----------------------------------------------ii tek %
----------------------------ls ----------------------------rd #-------------------dh nj ls
----------------------------ls ----------------------------rd #-------------------dh nj ls
----------------------------ls ----------------------------rd #-------------------dh nj ls
iii okilh
%
-------------------------ls -------------------------------rd #-------------------dh nj ls
-------------------------ls -------------------------------rd #-------------------dh nj ls
-------------------------ls -------------------------------rd #-------------------dh nj ls
iv tek esa 'kq) cdk;k
-----------------------------------------------

v vkosnu ds le; tek esa 'kq} cdk;k

%
----------------------------------------------7- visf{kr vfxze dh jkfk
%
-----------------------------------------------8- d iz;kstu ftlds fy, fudklh visf{kr gS
%
----------------------------------------------[k
fu;e ftlds varxZr fuosnu dk fooj.k
fn;k gS
%------------------------------------------------9- D;k blls iwoZ blh iz;kstu ds fy, dksbZ
fudklh dh xbZ] ;fn dh gS rks jkfk ,oa o"kZ nkkZ,Wa
%------------------------------------------------10-lkekU; Hkfo"; fuf/k ys[kk j[kus okys vf/kdkjh dk uke
%---------------------------------Ukkxiqj] fnukad ------------------------------vkosnd ds gLrk{kj
%----------------------------inuke

%----------------------------

GEOLOGICAL SURVEY OF INDIA (CR)

ACCOUNT - II - SECTION
APPLICATION FOR WITHDRAWAL FROM G.P. FUND
1.

Name of the subscribe

______________

:-

2.

Account No.
_______
Designation
_______

:-

Pay
_______
Date of Joining service and
_______
the date of superanuation
balance at credit of the
_______
subscriber on the date of
application as below

:-

3.
4.
5.
6.

i) Closing balance as per

statement for the year

:-

::-

:-

______

ii) Credit :From

To

@ Rs.

From

To

@ Rs.

From

To

@ Rs.

To

@ Rs.

From

To

@ Rs.

From

To

@ Rs.

iii) Refunds :From

iv) Net balance at credit

:-

7.

Amount of withdrawl required :-

8.

(a) Purpose for which the

withdrawal required
(b) Rule under which the
request is covered.

::-

9.

Whether any withdrawal was

taken for the same purpose
earlier, if so indicate the amount
and the year
:-

10.

Name of the account officer

maintaining the G.P.F. account :-

Nagpur
Date

______

Signature of the applicant :_____________

Designation

:-

_______

1.

/'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''' '''''''''''''' / /
/ '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

2. :

3.

1.
2.
3.
4.
5.
6.
7.
4.
3 90
5. 3 /90

.


. 15

. /
. '''''''''''''''''


. '''''''''''''''''''
. . ''''''''''''''''''''''''''''''''''''
.

. () () ()

:
:


/ / /
........................../- (................
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''')

.............. .................
/

................................................'
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''
/'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

6. ............................................... //

7. :8. () 90%

................../................./................/-

9.
10.
. () ()

................../................../-

L.T.C. ADVANACE APPLICATION FORM

CERTIFICATE
A. I Shri/Smthas/have applied for
days Earned/Privilage/Casual leave and shall be proceeding to my home Town/Place
Viz .Rly. Station
B. I shall be availing of leave travel concession in respect of my-self and the under
mentioned of my family accompanying me :-

Name

Relationship

Age
1.
2.
3.
4.
5.
6.
7.
C. I shall be drawing advance for myself and the abovementioned members of the family for both
the onward return journeys and the prior of anticepated absence will not exceed 3 months or 90
days.
D.

If the period of absence on leave exceed 3 months/90 days. I shall be immediately refund half of
the advance drawn.

E. I am a temporary Govt. Servant and surety bond of permanent Govt. Servant is attached. The fact
that the surety is a permanent Central Govt. servant has been certified by the office of his/her
employment.
F. I shall refund the amount of advance immediately if the outward journey is not commenced
within 15 days of the grant of advance.
G. The travelling allowances claim in (d) adjustment of the Advance will be submitted within one
months of the completion of the return journey duly supported by money receipts for purchase of
Rail tickets.
H. I shall be travelling by rail in 1st/2nd Class sleeping accommodation.
I.

I have duly completed one year continaeous service on the date of commencenent of journey
i.e._______________________

J.

I am availing of concession of the first time during the block year_________________

K. My Basic pay is Rs.________________________/- only.

L. I shall travel in the class for which the advance is drawn in the event of my subsequent travel in
lower class for some unforseen reason, I shall immediately refund the difference of advance
between Higher and lower class.

M. I Shall strictly observe the instructions contained in clauses (D),(F),(G) ? and I and in case of any
deviation I shall be submitting to disciplinary action.
Signature of Individual
Nagpur :
Dated :

Requisition of advance of leave travel concession

Please pay a sum of Rs_____________/- (Rupees in words
___________
_______________________________) only to me on account of advance of
Leave Travel Concession for proceeding to my Home Town/ Place on
regular/casual/leave. The details of advance is given below. I have aplied for
Earned/Casual leave for the period from ___________ to
_________________

Signature
________________________
Name of the applicant
_________________________
Designation
_________________________
Division/Sec.
_________________________
DETAILS OF ADVANCE
a) 1st/2nd/AC_________Class Railway fare
Rs.______________/from ________________to_______________________
Sleeper charges
Rs.______________/b) Government liability :c) Admissibility of advance i.e. 90% of (A)
Rs.______________/d) Total number of tickets to be purchased

for bothways journey

Nos._____________/e) Total advance required (D) & (E)
Rs.______________/-

Lskok esa]
iz'kklu vf/kdkjh ys[kk-----------------------------]
Hkkjrh; HkwoSKkfud losZ{k.k]
e/; {ks=]
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eq>s :- -----------------------------:i;s
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A
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fnu dh nj ls #------------------------3-vU;
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:----------------------v{kjks esa
:i,--------------------------------------------------------------------------------------------dqy jkf'k
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fo/khor~ Hkjk gqvk rFkk esjs i{k esa
Jh----------------------------------------------------------------------------------------------- }kjk gLrk{kjhr vko';d fuf'prrk ca/k flD;wfjVh
ckaM bl iz;kstu gsrq layXu dj jgk gw A
Hkonh;]
gLrk{kj
ukxiqj] fnukad

uke &
inuke

izHkkx@vuqHkkx@dks"B
Hkk-Hkw-l-] e-{ks-] ukxiqj
Hkkjrh; HkwoSKkfud losZ{k.k] e/; {ks=
la---------------------------@6@e-{ks@;k=k HkRrk
ukxiqj fnukad %
iz'kklu vf/kdkjh] ys[kk
] Hkk-Hkw-l-] e-{ks-] dks
vfxze vko';d dkjZokbZ ds fy, vxzsf"kr A
funs'kd@izHkkjh vf/kdkjh
To,
Admn. Officer (A/C._____________________)
Geological Survey of India
Central Region
Nagpur
(Through Proper Channel)
Sub.- Application for the grant T.A. Advance of Rs.______________
Ref. : office order No.__________________________________Dated :
I have been directed to proceed to camp :

on official

tour with immediate effect. I shall be grateful if kindly grant me T.A. advance Rs.
(Rupees

) break-up of which is

given below in order to enable me to proceed on tour.

1.Train/Bus fare charges from :

to

Rs.

(To and fro)

2.

D.A. for

3.

Other incidental charges, if any ...

Rupees in words :

Days @ Rs.
...

/- per day .. ..
...

...

Rs.

..Rs.
Total amt. Rs.

I am a temporary/permanent Government Servent. I enclose herwith necessary

surety bond duly filled in and signed by Shri
on my
behalf, for the purpose.
Nagpur :
Yours faithfully
,
Dated :
Signature :
Name :
Designation :
G.S.I. (CR)

No.

Geological Survey of India (C.R.)

/6/CR/TA
Nagpur the
Forwarded to the Admn, office A/C (

) G.S.I. CR. for further necessary

action

Director/Officer-in- Charge

Hkkjrh; HkwoSKkfud losZ{k.k] e/; {ks=

R;kSgkj vfxze iznku djus gsrq vkosnu i=
uksV %
1- ;g vfxze dsoy vjktif=r deZpkfj;ksa ds fy, ns; gS] ftudk osru #8]300@& ls vf/kd
ugha gS A
2- vfxze dh vf/kdre ns; jkfk ,d eghus ds ewy osru ds cjkcj ;k #-3750@&
tks Hkh de gks]
ds cjkcj gksxh A ;g vfxze dSysaMj o"kZ esa dsoy ,d ckj ns; gksxk A
3- vLFkk;h 'kkldh; deZpkjh ls izkIr bl vfxze gssrq vkosnu i= ds lkFk
fufprrk ca/k flD;wfjVh
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4- ;g vfxze 10 cjkcj jkfk dh fdr }kjk iquizkZIr fd;k tk,xk] ftlesa igyh
iquizkZfIr
vfxze izkfIr ds vxys osru fcy es ls dh tk,xh A
5- vkosnd us ;fn dksbZ R;kSgkj vfxze fiNys ckj fy;k gks rks mls iw.kZ #i
ls okil dj fn;k gksuk
pkfg, A
6- vkosnu i= izHkkxk/;{k ds ek/;e ls izsf"kr gksuk pkfg, rFkk ;g lacaf/kr
ys[kk vuqHkkx dks R;kSgkj ls
20 fnu igys igqp tkuk pkfg, A
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------

1- vkosnd dk uke
%
2- LFkk;h] LFkk;hor~ ;k vLFkk;h
%
3- ;fn vLFkk;h gks rks vkosnd }kjk /kkfjr
LFkk;h in ds ckjs esa tkudkjh ;fn dksbZ gks %
4- inuke
%
5- izHkkx@vuqHkkx
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6- orZeku ewy osru

%
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%
8- vkosfnr vfxze dh jkfk
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13-D;k 'kklu }kjk izk;ksftr fdlh ioZrh; LFky ij
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fn;k gS %
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tkudkjh ds vuqlkj iw.kZ #i ls lgh gSa A
LFkku % ukxiqj
fnukad %-----------------------------vkosnd
ds gLrk{kj%
inuke %
izHkkx@vuqHkkx@izdks"B%

GEOLOGICAL SURVEY OF INDIA (CR)

APPLICATION FOR GRANT OF FESTIVAL ADVANCE
NOTE :
1.

The advance is admissible only to non- Gazetted staff whose basic pay does not exceed Rs. 8300/-

P.M.
2.

The maximum amount of advance admissible is one months basic pay or Rs.3750/- which

over is

less. The advance will be admissible only once in calender.

3.

Application from temporary Government servents should be accompanied by a surety bond from a
parmanent Governmnent Servent.

4.

The amount of advance will be recovered in not more then ten equal instalments, the first recovery
commencing with the next pay bill.

5.

The application should be routed through the divisional Heads and it should be reached in
concerned A/C section before 20 days of the festival.

----------------------------------------------------------------------------------------------------------------------------------

1.

Name of applicant

2.

Whether perment Q.P. or Temp.

3.

If temporary, give particulars of permanent :

post if any held by the applicant

4.

Designation

5.

Section

6.

Present Basic pay

7.

Festival for which the advance is applied for :

8.

Amount of advance applied for Rs.

9.

Amount and number of instalments in which

the advance should be recovered

10.

:
:
:
:
:

If temporary, whether a surety bond has been

attached from another permanent Govt.Servent

11.

Particulars of Surety

12.

Whether the applicant has drawn any

festival advance earlier during the current calender year

13.

Whether any advance for Govt. Sponsore trip to hill

station has been taken during calender year :

14.

Whether the festival advance taken on the

last occasion has been fully repaid

15.

I verify that the facts state above are true to best of my knowledge and behalf.
Nagpur

Signature of the applicant :

Dated

Designation :
Section/Division: