APPLICATION FORM FOR GRANT OF L.T.C.ADVANCE
1.
Name of
Municipal servant
2.
Designation
3.
Date of
entering the Municipal service
4.
Present
Pay
5.
Whether
permanent or temporary
6.
Home
town as recorded in the service book
7.
Whether
wife/husband is employed and if so whether entitled to L.T.C.
8.
Whether
the concession is to availed for visiting Home town, and if so block for which
L.T.C is to be availed
9.
(a) If the concession
is to visit anywhere in
(b) Block for which to be availed
10.
Single rail
fare/ bus fare from the headquarters to home town/place of visit by Shortest
route
11.
Persons
in r/o whom L.T.C is proposed to be availed.
_____________________________________________________________________
_____________________________________________________________________
12. Amount of advance required. Rs
I declare that the particulars furnished above are true and correct to the best of my knowledge. I undertake to produce the tickets for the outward journey within ten days of receipt of the advance.
In the event of cancellation of journey or if I fail to produce the tickets within ten days of advance, I undertake to refund the entire advance in one lump Sum.
Date
Signature
(P.T.O.)
CHECK-LIST
(For
use in office)
1.
Particulars
in
2.
Amount
entitled for reimbursement
.
3.
Advance
admissible (80% of amount in 2)
Advance
of Rs
..may be sanctioned
OR
The advance is not
admissible since:-
1.
The
official has not completed the minimum service.
2.
The
official has not utilized the earlier advance for the L.T.C which was not
refund by the official in time, but subsequently recovered with/without penal
interest.
3.
.
D.A (
)
Office Supdt.( )