Application for LTC Advance

DEPARTMENT OF POSTS

Application for LTC Advance

1. Name of applicant                                                               :                                                          

2. Designation & Office                                                           :

3. Whether permanent or temporary (if temporary surety

    Bond from a permanent Govt. servant other than a

    Member of Gr ‘D’ staff should be attached                           :

4. Date of appointment                                                             :

5. Basic pay                                                                             :

6. i) Home Town as recorded in the service book.

 

  ii) Place to be visited ( anywhere in India)                             :

7. Nearest Railway station (write in capital letters)                   :

8. Instance between place of duty and the HOME TOWN /

    Place to be visited as shown in col.5 of above                       :

9. Whether the applicant has completed / will complete one

    One year of service on the date of commencement of

     Journey                                                                              :

10. Two year / Four year block for which the LTC is desired

      To be availed of ( Block year may be given                          :

11. Nature and period of leave                                                   :

           

12. Particulars of persons who are to avail of LTC                      :

Sl No	Name of Person	Age	Relationship with the Govt. servant

13. Total No. of tickets / ticket                                               :

14. Date of commencement of the onward journey                  :

15. Whether intention to avail of the LTC has been intimated

      Formally in advance, if not necessary formal intimation

      May please be given now.                                                 :

16. How is the journey to the place to be visited to be

      Undertaken by the officer/ official (is) whether by Rail,

      Road or both.                                                                     :

17. Amount of the advance required ( Breai-up) of the

     Advance required                                                                :

i)                    cost of single fare for outward journey only by rail or road

ii)                  cost of the outward journey for all persons               :

       iii)          cost of the return journey for all persons                :

      iv)        Total amount of OUTWARE & RETURN journeys :

       v)           LTC advance admissible (only 80% of 17 (iv)        :

18. Whether LTC was availed during the previous block of four years:

19. Whether final bill in respect of the previous LTC advance has

      Been submitted and since passed                                         :

20. i) I hereby affirm that all the particulars furnished are true to the

         Best of my knowledge and belief                                       :

ii)I certify that my son(s)/ daughter(s)/ Father/ mother/ brother(s)

   sister(s) mentioned above are residing with and wholly

   dependent on me.

iii)I undertake to refund in ONE LUMP the LTC advance granted

    to me in case outward journey is not commenced within 60

    day of the grant of the advance.

iv)I undertake to produce the cash receipts or full details of the

      cash receipts for the outward journey with in 10 days from

      the date of grant of  advance.                                        :

v) I undertake to submit the TA bill for the journeys performed

    WITHIN A MONTH of the completion of the return journey

    Along with necessary cash receipts for both the onward return

    Journeys.

vi) In case any part of whole amount of the advance now granted

     become recoverable form me, I undertake to refund the entire           

     FORTH WITH IN ONE LUMP.

vii) I also undertake to pay penal interest on the outstanding

      advance.

viii) I undertake to enclose necessary prave for having reached the

       declared place of visit and the particulars of tickets for the

       return journey with my TA bill to be submitted later.

Place:                                                                                             Signature of the official

Date:                                                                                              Designation:

………………………………………………………………………………………………………….