Ltc claim.doc

8/22/2019 Ltc claim.doc

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COUNCIL OF SCIENTIFIC & INDUSTRIAL RESEARCH, NEW DELHI.

BILL FOR LEAVE TRAVEL CONCESSION

(For the Block year )Note: The bill should be prepared in duplicate one for payment and the other as office copy

PART A

(To be filled in by the Govt. servant)

1. Name : 2. Designation :

3. Pay : 4. Headquarters :

5. Nature and period of leave sanctioned 6. I.D No:

Nature of leave:.................................................................. ,From

9. Particulars of members of familyin respect of whom the LTC has been claimed

O. M. No: Date:

SI No. Name (s) Age Relationship with the Govt Servant12

7. Details of journey(s) performed by the Govt Servant and the members of his Iher family:

Place of Departure,

Date & Time

Place of Arrival Date

& Time

Mode

of

Trave

l

Class of

Accommodati

on Used

No of

Fares

Fares

Paid

Rs P

Remarks

Ticket No./

Train No.

8. Amount of advance, if any, drawn : Rs, No advance was drawn

9.Particulars of journey (s) for which higher class of accommodation than the one to which the Govt.Servant is entitled, was used (Sanction No & Date to be given)

PlaceFrom To

Mode ofConveyance

Class towhich

entitled

Classby

whichactuall

No. ofFares

Fares PaidRs P.

.

10. Particulars s) performed by road between places connected by rail:


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Name of placeFrom To Class to which entitled

Rail FareRs. P

.


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CERTIFIED THAT

1. The information as given above is true to the best of my knowledge and belief;

10. That my husband Iwife is not employed in Govt. Service Ithat my husbamd Iwife is employed in Govt.Service and the concession has not been availed of by him Iher separately for himselfIher self or forany of the family members forthe concerned block of years ......__ ......................................to ..................................................

11. That my wife Ihusband for whom LTC. is claimed by me is employed in .(name of the Public Sector Undertaking ICorporation IAutonomous body etc.) which provides L.TC.facilities but she has not preferred and will not prefer, any claim in this behalf to his Ihe employer; and

12. That my wifeI

husband for whom L.TC. is claimed by me is not employed in any Public SectorUndertaking ICorporation IAutonomous Body financed wholly or partly by the Central Govt. or LocalBody, which provides L.TC. facilities to its employees and their families.

DECLARATION SUBMITTED BY CLAIMANT

I hereby solemnly certify that my family members and I did actually undertake the journey to and from theplace(s) on the said dates mentioned in this claim and that the financial claim made and all the particulars oftravel furnished by me herein are true and genuine I have read and understood the LT C. rules and I take fullresponsibility for all the statements and claims made herein by me. I hereby undertake that I Shall abide by theverdict of any action that the DIRECTOR, CSIR. may take against me in the event of my claim made herein

being found to be false now or later.

Date:

BILL No.

PART - B

Signature of Council Servant

DATE(a)

(b)

(c)

Railway IAirIBus ISteamer Fare

LESS Amount of advance drawn already

Amount refunded vide C. R. No.Balance

dt

Rs.

Rs.

Rs.

(if any) ... Rs.

(d) Amount recommended for payment

(Rupees .

2. The expenditure is debitable to

Signature of Drawing and Disbursing Officer

COUNTERSIGNED

Please pay to SB A/c No.BANK,NEW DELHI

Signature of the Controlling Officer DIRECTORICONT. OF ADMN

Certified that entries have been made in the Service Book of Shri ISmt. IKum .

.... ............................................................................at Page No.

Signature of the Officer authorised (to attest entries in theService Book)

Pay Rupees


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Section Officer (F &A)Sr.Finance and Accounts Officer

Ltc claim.doc

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