t.7.TIT,-14(.

7
G.A.R.-14C: 71 C. ub 11 No.
31-4- 714T tri4T Rqugri fcri
Leave Travel Concession Bill for the Block of r71 Year 14q
fatcrit-.7 vrTZ f9T; sHa
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NOTE-This bill should be prepared in duplicate—one for payment and the others as office copy •
%TT (11"%iftcic gruITU M91- W) PART-A (To be filled up by Government Servant)

1. ii44/Nanie
2. LK-IP-I/Designation 3. «d-t/Pay

4. t.R9'41c-F4/1-leadquarters
5. Pt7 3Tawm T9-TR a .31t.fi

Nature & Period of leave sanctioned From To

6. ..31 ,41-,1:n Giar fTI 1*1 f3—d1711:
Particulars of members of family in respect of whom the LTC has been claimed.:-

- •
Details of journey(s) performed by Government servant and the !miter of his/her family:
1
1 TIP-Tri/D e pa r tu re .3TrTrgibk rri v a 1 01 . 7r-ir t ilf-4 4rT. Wit ilit ift 1# 7 4141 111-1
I II(111 6t\R mt 3iiff f4. ^1141 e. i '4 "ATI 3 IthlTi VT 71 4-its,clf Fare PaidI
I uHL1 '4 . 771 7W Distance .n ' Mode of travel and class No of
'Date and Time From Date and Time To Kilomete's of accomolation used fares Fa s. dI i
2 3 - 4 5 6 7 8 1
I 1
I I
I I
I I
r 1
1 1
1 I
L
I
,I
I I
I I
I . I
1 1
I
I I
I I
1 1 1
[8. 3-Tr74 TI 01 14, t t/Amount of advance, if any drawn Rs.
 -2/LTC-

I 9. tilAt 1,Arift,,A, Trc*-Ta -4-4T -4 TR fiaT1:1-Till,f-A17471d7 ,qtt t dmmIcR Ti tircit.T1 37h f3f-,i4f ti
(- it-t71- -gun a tin t
Particulars of journey (s) for which higher class of accommodation than the one to which the
Government servant is entitled was used. (Sanction No. and Date to be given):-
te4H Place ar-0-9 Tr r? ari -Nirrwr c.t a-ri Wi aRliNt
- iTr .T 51Srf
ATTT -)c1 4. t Fq A 0-INI 1-11T
cl* Mode of Class to Class to which No. of Fare Paid
From To Conveyance which entitled actually travelled Fares F./Rs. 4/P.
/ .2 3 4 5 6 7

i---

10. )?( q1A1P-11711A

nf innrnpv nprfnrmpri hv rnari hP1-tvPPn nlarPc ennnpetpd hv rail

VIMTIff 14ett WIRT M Certified that the ::

1. 3711- 17417R f47-4F-i 3TFITT
Information as given above, is true, the best of my knowledge and belief.
2. fT 1)1.* tit/qc--1 TR-Tit t/fT frfaiqici 17-*--rft 4-4T t3 332T1 trftaR
Illif"4-rd 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 him/her separately of himself/herself or any of the family
member for the concerned block of TF-Ti years3177 qe. 7-1 711 t

TfTEI/Date ?I'Mft Mg/Signature of the Govt. Servant

 3/LTC

nTrr-u (f=47 wIN-Fr 371- 7r--4r i)

PART-B (To be filled in the Bill Section)

1. ik -,c1.(1 TO cfril -fq - */ Rii r7 *1

The net entitelment on account of Leave Travel Concession works out to To Rs.
as detailed below :-

() 947
(a) Railway/air/bus/steamer fare Rs. T. Rs.

(u) 1-171:r 0:1 of16 -ci<

•

(b) Less amount of advance drawn vide voucher

No Dated Rs.

ittf AT/Net amount -& Rs.

(2) c1-44 raqc4H 11 ,4t1

-

(2) The expenditure is debitable to

fetw arram afTUT ark dt4UM aff4Tft Miff(

Initials of Bill Clerk Signature of Drawing & Disbursing Officer

TAM/Rift Countersigned
1i4*i' 311U TRTRTi Signature of Controlling Officer

vi:rftra ftql tt

Nis5fitrra/Trrrt

Certified that the necessary entries have been made in the Service Book of

Shri/Shrimati/Miss

tri-47T1 I cIFYd fTTfr-ra 3iftrwit '4711UT

Signature of the Officer authorised to attest entries in the Service Book

4- -
Printed 12 , : Go al Stationers, Delhi-7 J
 4/LTC

L.T.C. CERTIFICATE
CERTIFICATE TO BE GIVEN BY THE CONTROLLING OFFICER
Certified that Sh./S mt./Ms. (Name of the Govt.
servant) has rendered continuous service for one year or more on the date of commencing the outward
journey.
) Certified that necessary entries as required under Para 3 of the Ministry of Home Affairs O.M. No.
43/1/55:Ests.( A) part H. dated 11th October. 1956 have been made in the Service Book of Sh./Smt./
Ms.

Signature & Designation of the Controlling Officer

CERTIFICATE TO BE GIVEN BY THE GOVERNMENT SERVANT

1. I have not submitted any other claim so far for Leave Travel Concession in respect of niyself or my
family members in respect of block of two years 20 and 20
2. I have already drawn T. A. for the Leave Travel Concession in respect of a journey performed by me/
my wife with children.
3. I have not alre,kciy drawn T. A. for the Leave Travel Concession in respect of a journey performed by
me/my wife with children/my family members in respect of block of
two years 20 and 20
4. lhave already drawn T.A. for the Lea ve Travel Concession in respect of a journey perfomied by me
in the year in respect of block of two years 20 and 20
This claim is in respect of a journey performed by me in the years
This is against the concession admissible once every year in a prescribed block for visiting home town
as all the members of my family are living away from place of work.
5. This journey has been performed by me with my wife with children/my
family members to the declared home town viz.
6. That my husband/wife is not employed in the Government.
That my husband/wife is employed in the Government service and the c ncession has not been availed
of by him/her separately for himself/herself or for any of the family members for the concerned block
of two years.
7. Certified that my wife/husband for whom L.T.C. is claimed by nr is employed in
Name of the Public Sec-
tor Undertaking/Corporation/Autonomous body etc.) which provides Leave Travel Concession
facilities but he/she has nor preferred and will not prefer any claim in this behalf to his/her employer.
8. Certified that my wife/husband for whom L. T.C. is claimed by me is not employed in any Public Sector
Undertaking/Corporation/Autonomous body etc.. financed wholly or partly by the Central Govern-
ment or Local Body which provides L.T.C. facilities to its employees and their families.

Signature of the Govt. servant