LTA PROOF SUBMISSION FORM

1. Employee ID :

2. Employee Name :

3. Designation :

4. Date of joining :

5. Details of leave availed From :

This is to declare that I have undertaken journey as per the details mentioned herein

Relation Copy of
with the Places visited Dates of journey Class/No.of
Name of the Mode of ticket/receipt
employee kms.in case
person travelling travel No.
of car/taxi
(Yes or No)
  Origin Destination From To

                 
                 

                 
                 
                 
                 

Total Cost of Travel: Rs.___________/-

I hereby declare that I have incurred a total expense of Rs. ____________ and attach the copies of
relevant tickets / receipts.

______________________
Date : Signature of the employee