LEAVE TRAVEL ASSISTANCE - EXEMPTION FORM

Employee Name 0 Company Name 0

Employee Code 0 PAN No. 0 Location 0

1. Period of leave : From To

2. Final destination of journey : From To

3. Mode of Travel : Air Rail Others

(Please tick whichever applicable)

4. Single journey fare to place of travel:

5. No. of Family members accompanying

:

6. Total of actual expenses on fare :

to final destination and back -

I hereby declare that the particulars furnished in the above L.T.A. form are true and correct and confirm that the
period of leave mentioned above has been sanctioned by my Department Head and debited to my Privilege Leave

Place:
Date: Signature of Employee

DETAILS OF ACTUAL EXPENDITURE ON LEAVE TRAVEL ASSISTANCE

Age Relation Traveling Distance in Mode of Air / Rail / Bus Ticket Fare Rs.
Name
From To Kms. Travel No.

Total -

Notes : -

1. LTA exemption should be claimed for only one journey during the financial year

2. If the journey is performed by Airways, e-ticket or boarding pass for both sides of travel issued by the airlines
should be enclosed.

3. If the journey is performed by Railways, e-ticket or copy of rail ticket for both sides of travel should be enclosed.

4. If the journey is performed by Roadways, the original bill of the transport agency should clearly
mention whether the journey was by AC / Non-AC car, the kilometers travelled and the rate per kilometer.

5. Bills of Authorized / Reputed Travel agents will be considered for exemption.

6. Proofs submitted for foreign travel will not be considered for exemption