INDIAN INSTITUTE OF
TECHNOLOGY,BOMBAY
Name / To be filled in by Admn. Section.
Designation / Sr. no. of Ta Inward
Deptt-Section / Register
LEAVE TRAVEL
CONCESSION BILL
Salary Code No. / Date of Receipt
Pay - Rs.
Particulars of Journey and Halts kind of journey i.e. by Rail (Mail or Passenger), Steamer, Air/Road/Trolley and class of Acmdtn./Distance No .of Fares Amount Remarks
Departure Arrival
Station Date Hour Station Date Hour

Total Amount claimed Rs.
Less : Deduction Advance
/ vide Vr. No.
Rs.

Date:

Net Claim Rs.

Date:

Signature of the Claimant

Passed for Rs.

ASSTT. REGISTER (Accts.)

CERTIFICATES TO BE GIVEN BY THE EMPLOYEE

  1. I have not submitted any other claim so far Leave Travel concession in respect of myself or my family member in respect of block of two / four years 20
  2. The journey has been performed by me / my wife with children to the declared home town/ any palce in India viz.
  3. That my husband / wife is not employed in Instt. / Govt. Public Sector Undertaking/corporation/Autonomous Body and any other Organistion which provides L.T.C. facilities to its employees. That my husband/wife is employed in the Institute/Govt./Public Sector Undertaking/Corporaton/Autonomous body and any other Organistion which provide LTC facility to its employees and their families but he/she has not preferred and will not prefer any claim in this behalf to his/her employer.
  4. Certified that distance for Road journey shown in the bill are correct to the best of my knowledge and beleif.
  5. An advance of Rs. was drawn by me for this purpose.
  6. Certified that I have travelled in the class of accommodation not lower than that for which fares were claimed in this bill and to which I am entitled.
  7. Certified that journeys mentioned in this bill has not been preferred not will be preferred or nor paid from any other source.
  8. Certified that concessional railway/air ticket was / was not purchased.

Signature of the Employee

CERTIFICATE RO BE GIVEN BY THE CONTROLLING OFFICER
Countersigned Certified that -

  1. The concession was not availed of more that one in two calenders years
  2. The journey was performed actually to the declared 'Home / any palce in India of the member of the staff is recorded in the Service Book.
  3. Name of the member of the staff has rendered continous service for one year or more on the date of performing this journey.
  4. The above certificates tally with entries made in the Service Book of
  5. The husband/wife of the member of the staff is not employed in the Institute or that the husband/wife of the member of the staff is employed in the Institute and the concession has been drawn only once for the family
  6. The member of the staff was actually on leave/vacation and before proceeding on leave he/she actually gave his/her intention of availing the concession.

Checked inAudit (Pre-audited/Post audited)


Admitted Rs.
Disallowed/Added Rs.

DY. DIRECTOR / REGISTRAR
DY. REGISTRAR, IIT BOMBAY

Sr. Audit Officer

ASST. REGISTRAR (AUDIT)