Note:- This bill should be prepared in duplicate- one for payment and the other as a office copy.
PART-A (To be filled up by the Government Servant)
1. Name :
2. Designation:
3. Band Pay:
GP :
Total Basic :
4. Headquarters :
5. Nature and period of Leave sanctioned, from
w.e.f
to
6. Particulars of Members of Family in respect of whom the LTC has been claimed.
Sl.No.
Name
Age
Relationship
;
7. Details of journey(s) performed by Govt. Servant & the member of his/her family.
Departure
Arrival
Dist. in Kms
Mode of Travel &class of accomm-odation used
No. of fares
Fare paid(Rs.)
Ticket No./ PNR No.
Remarks
Date & Time
From
Date & Time
To
Total Fare:
8. Amount of advance, if any, drawn Rs.
9. Particulars of journey(s) for which higher class accommodation than the one to which the Govt. Servant is entitled, was used (Sanction Number & date to be given).
10.
Place
Mode of Conveyance
Class to which entitled
Class by which actually traveled
No. of fares
Fare paid
From
To
Rs.
Paise
11. Particulars of Journey(s) performed by road between places connected by rail:-
Name of Places
Class to which entitled
Rail Fare (Rs.)
From
To
Certified that :-
Information are given above is true to the best of my knowledge and belief.
That my husband/wife is not employed in Govt. Service/ that my husband/wife is employed in Govt. Service and that concession had not been availed of by him/her separately himself/herself or for any of the family members for the concerned Block Year of
.
That my husband/wife for whom LTC is claimed by me is employed in
which provides leave travel concession facilities but he/she has not preferred and will not prefer any claim in this behalf to his/her employer; and
That my wife/husband for whom LTC is claimed by me is not claimed by me is not employed in any Public Sector Undertaking/Corporation/Autonomous body financed wholly or partly by the central government or Local body, which provides LTC facilities to its employees and their families.
That my father/mother/sister/brother is/are fully dependent on me and their income is less than Rs.500/- per month and he/she/they is/are residing with me.
Date:
Signature of the Government Servant.
CERTIFICATE TO BE GIVEN BY ADMINISTRATION
Certified that necessary entries have been made in the service book of
Joint declaration / certificate received from his / her husband’s/ wife’s office. He/She will avail LTC and other benefits from this office.
Signature of the Officer authorized to attest entries in the Service Book
PART- B (To be filled in the Bill Section)
The net entitlement on account of Leave Travel Concession works out to Rs.
- as detailed below:-
(a) Railways/Air/Bus/Steamer fare Rs.
(b) Less amount of advance drawn Rs.
(c) Vide Bill No.
Dated:
(d) Net Amount:-Rs.
The expenditure is debitable to: SALARIES
Passed for Rs.
Issue Cheque in favour of:-
for Rs.
……………………….. ……………………………………….. Initials of Bill Clerk Signature of D.D.O.
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