APPLICATION FOR LEAVE TRAVEL CONCESSION ADVANCE

BLOCK YEAR 19 - 19

1. I shall be on vacation from to
I have applied/been sanctioned leave from to
during which period I wish to avail of the Leave Travel Concession for myself and my family.
3. II AC I/II *I/We intend to travel by II AC/I/II Class by Rail
4. My Basic Pay is Rs.
5. The particulars 0f the dependent family members wishing to proceed to home town/any place in India are as given below :-

Sr.No. Name of the dependent family member
(wife,children,parents,minor brothers and sisters)
Relationship Age
1.
2.
3.
4.
5.
6.
7.

6. Home Town declared
Any place in India chosen for visit(farthest point)
Dist    State
Nearest Railway Station

8.

  1. I shall refund fortheith the advance if the outward journey is not commenced within 30 days of the drawal of the advance.
  2. I shall prodeice railway tickets in respect of onward journey for vertication within 10 days from the drawal of the advance.
  3. I am aware that I am required to produce Bus Tickets for road journeys and to furnish ticket nos. in respect of return Rly.journeys.
  4. I shall prefer my L.T.C. claim IMMEDIATELY on the completion of the RETURN JOURNEY.

Delete which is not applicable

Date :

Signature __________________
Name
Salary Code No.
Designation
Department/Section