;;lro~oaTRo-14/GAR-14

~-f.wnto/Sub Bill No. . .. . .. -ao f.f-25 W/T.R.25C

"CIi ~ trai t- c;:;rrq; t- ~ ~ (Jl"5Il ~ fcIFr
Leave Travel Concession Bill for the block of year
fculuft:- <ffl f.R;f <U ~ -q, ~ ~ ~ ~ ah ~ ~
fctllrr \ifRT ~ I
Note - This bill should be prepared in duplicate-one for payment and the other as office copy.
llfu *~ m To .

'qJ1f-(Ji (~ ~ wn \ffi \ifRT ~)

PART-A (To be filled up by Government servant)
1. ~I Name 2. '1<AJlt/Designation .
3. ~/pay 4. ~ IHeadquarters .
5. . ~ ~ ~ ~ lIt ~ ~ Wfiffi ~ ~
Nature and period of leave sanctioned, from to .
6. ~ ~ ~ fqf~lfP!'4i, ~
~ onorn ~ <m1TW.fT'4(;CI'iTCUClTfctllrrl1<IT~
I
Particulars of members of family in respect of whom the L.TC. has been claimed.
s;fi11 ~o ~ ~ ~m~~
SI. No. Name ..,/\ge Relationshipwith the Govt .
Servant.

1.
2.

3.

4.

5.
6.

7. ~~ah~~*~IDU~lIt~(~)*~
Details of Journey(s) performed by Govt. servant and the members of his/her family :-

~ ~ l.lm~Ufuah
Departure Arrival
~ ~.~<tiT 'ZIDit ~
~ah ,~~ ~~'. ~ fctquit
~ OI"fug·ah Qcf; fit; 0 fir 0 .q fctllrr l1<IT" ~o ~
~ ~ Remarks
From To Distance Mode of Travel No. of Fare
Date & Date &
Time in Kms. and class of accomm- fares Paid
Time odation used
lio/Rs

.
-

s. ~ lTQ. ~ ~ ~, ~ ~ ~ •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• lio

Amount of advance,if any, drawn Rs .
OJ ~ <m1T/~ <m1TaIT <fit fqf~lfl'!<li ~/~ ~ ~ ~ ~ ~ qtf~, ~ ~ ~ l ~ qtf <fit~ ~ <tiT
~~~I .
Particulars of journey(s) for which higher class of accommodation than the one to which the Govt. servant is entitled, was uSi.,d
(Sanction Number and Date to be given).
.•.

~ ~ ! ~qtf~ <mit 1ll6T ~<mft

Place ~ ~:<fm <fitM ~
~<tiTJRiR ~~ <fit~ No. of Fare paid
~ Qcf;
Class to Class by which fares
From To
Mode of conveyance
which lio I ~o
" .,---,_ entitled
actually
travelled I - Rs. I
,
p

- -_. I . ,
--~-.-
I
--."--
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i
i _.' ___ ;"'.~ ..... _, _ _.-J__
j
 2
10. m ~ ~~ ~ ~ afitl. ~ 1Wf ~ 'fit "ITt <mrr/<mrran ~ ~ ;-
Particulars of journey(s) of performed by road between places connected by rail:-

Name
~C1" ;:w:r
of Places
m"lrr;ft ~
Cf6~~~~ Rail fare
it i'fcf) Class to which entitled ~o
From To Rs.

I
:
!
I
JIlllfirm ~ ~ ~ fcn I Certified that the
1. ~cfilf{ ~ lIT ~ ~~ ~ ~ ~ ~ ~, ~
Information. as given above is true to the best of my knowledge and belie! anc
2. ~ 1:!fu/-qu ~ mCf>TiT ~ 1) ~ ;fflI' ~/iro 1:!fu/-qu ~ mCf>TiT ~ 1) ~ ~ aiR ~ " Gf5f
~ GffiCfi ~ ~ ~ ~ <IT ~ ~ fcnm ~ ~ ~ ft?w«; <fiT ~ ~ fcf;<rr ~ ;
That my husband/wife is not employed in Government servicelthat my husband/wife is employed in Government service
and the concession has not been availed of by him/her separately or himself/herself or for any of the family members for the
conected block of . . years

m<fiR1 m ~~8;'RI Signature of Government servant

i'I'T'fug J Date

'ijJlf-~ ( faR; ~\lfIT ~ '1U ~ ~ )

PART - B (To be filled in the Bill Section)

1. ~ <mrr ~ ~ ~ ~ qo aRt ~ ~ ~ ~ ~ ~ ;_
The net entitlement on account of leave travel concession works out to Rs as detailed below :_
(Cfi) m/~/~/~ <!'lit ~ q0
(a) RailwayslAirlBus/Steamer fare Rs " ..
(~) ~ ~ 0 i'I'T'fug ~ ~ ~ ~ artW:r 'fit \<fil1 'fit tm ~ I
(b) Less amount of advance drawn vide Voucher No date \o/Rs ..
~ \<fil1/Net amount {o/Rs.

2. c;;q<f 1) Fcl Of> <A 41 <I ~ I

The expenditure is debitable to

faR; ~ ~ amJml Initials of Bill Clerk -3ITGR ~ ~ ~ ~ ~/ Signature of 0.0.0.

l!ftr 6~1~R:11 / Countersigned

~ ~ <fiT ~I Signature of Controllinri Officer

w:nfORr ~;jfJ'ffi' ~ fcf; llit/~/~o ~ 'fit ~
~1)~~<fi\cfi"lTt~1
Certified that necessary entries have been made in Service Book of Shri/Shrimati/Miss .

~ ~ 1) 'fit ~ Cf>1 OijJllilfUl11 Cfi'8 ~.~.~ ~. it; ~

Signature of the Officer authorised· to attest entries in the Service book.

~ / MGITBP Bbsr - 2/2 - GIFS 12013-14 - 2,50,000 Copies.