Government of India
APPLICATION FOR GRANT OF L.T.C. ADVANCE
1. Name of the Government Servant :
2. Designation :
3. Emp. Code No. :
4. Telephone / Intercom No. :
5. E-Mail address :
6. Date of entering the Central :
Government service
7. Pay :
8. Whether Permanent or Temporary :
9. (a) Home Town as Recorded in the :
Service Book
(b) Nearest Railway Station :
10. Whether wife / husband is employed : YES / NO
& if so whether entitled to L.T.C. : YES / NO
11. Whether the concession is to be : YES / NO
availed for visiting home town, Block Year ________________
and if so Block Year for which
L.T.C. is to be availed.
12. If the concession is to visit : Place ________________
"ANYWHERE IN INDIA", name the place
to be visited and Block Year for Block Year ________________
which L.T.C. is to be availed. :
13. Nature of leave ................ from ............ to ............
OR
* Proposed date for onward journey & :
Proposed date for return journey :
14. Single Rail/Bus fare from the :
Headquarter to Home Town/place
of visit by shortest route.
15. Persons in respect of whom L.T.C. is proposed to be availed :-
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Sl. No Name Age Relationship
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16. Amount of advance required Rs. ...........
17. 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 the journey or if I fail to produce the
tickets within 10 days of the receipt of the advance, I undertake to refund
the entire advance in one lumpsum.
Dated : (Signature of the applicant)
* Applicable in case of advance required for family members only.
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CHECK LIST (Cash and Accounts Section)
1. Amount entitled for : Fare Rs. ......X 2 X (No. of tickets)
2. Advance admissible ( 90% of the amount i.e. Rs. ...........)
Advance of Rs. ...............................................
may be sanctioned.
Dealing Hand. Signature of D.D.O.
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CHECK LIST FOR ADMINISTRATION
L.T.C. advance to __________________________________________________
1. Block Year / Calendar Year :
2. Home Town / A place anywhere in India :
3. a) For whom advance is applied for :
b) Total number of persons :
4. Specific grounds waranting sanction : for both/ onwards/ return
journey of advance under Rule G.F. 235 (2) (iii) (a)
5. Leave application received : Yes / No
6. Amount of advance : Rs.
7. Temporary / Permanent :
8. If temporary (Surety bond produced) : Yes / No
Necessary entry has been made in the L.T.C. Advance Register.
He/She is eligible for L.T.C. for the Block/Calender Year ...............
We may sanction the advance as per fair sanction letter placed below for
approval & signatures of D.D. (Admn) please.
Dealing Hand (Section Officer)
D.D. (Admn)
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