LTC_Claim_Form

CENTRAL COUNCIL FOR RESEARCH IN AYURVEDIC SCIENCES
NEW DELHI
APPLICATION FOR CLAMING REIMBURSEMENT OF TRAVELLING EXPENCES FOR VISITING
HOME TOWN UNDER THE MINISTRY OF HOME AFFAIRS OFFICE MEMORANDUM NO. 43/1/55-
Estt. (a) Pt. II
1. Name :
2. Designation :
3. Present Pay :
4. Date of Entry in CCRAS Service :
5. (i) Home Town as declared under Ministry of :
Home Affairs O.M. No.343/1/55-Estt. (A) Pt.II
dated 11th October 1956 or L.T.C. for any place
anywhere in India.
(ii) Nearest Railway Station to the Home Town (if :
not connected by Rail)
(iii) Distance from Headquarters by shortest route. :
6. When was the concession last availed of (Give :
here the date of outward journeys and block years.
7. Period and nature of leave during which journey :
to and from the Home Town were performed.
8. Date of application in which the controlling :
officer was informed of the intention of availed of
the travel concession.
9. Members of family, including self with their :
respective relationship with the Government
servant for whom concession is sought.
Name Age Relationship
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(In case concession is claimed only in respect of members of family. State whether leave was refused to the Government
Servant).
10. Class of accommodation of railway by which :
(i) Entitled :
(ii) Actually travelled :
11. Whether any part of the journey, otherwise :
connected by rail was performed by road or
steamer.
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12. Particulars of travel such as outward:-

Journey Date :
Tickets Nos. :
Cash receipts etc. from :

13. Note Ticket Nos. Fare
Money Receipt for Railways Tickets 1.
should be attached 2.
3.
4.
5.
6.
Total Rs. (A)
Return Journey date
from ___/___/______ To ___/___/______
Ticket Nos. Fare
1.
2.
3.
4.
5.
6.
Total Rs. (B)
(A+B) Grand Total Rs.
14. Nearest bus station to the Home- :
Town.
15. Amount of L.T.C. advance drawn if :

any.
16. Any other information which the :

application likes to give
17. Certificated to be signed by the :
Government Servant
-3-
Certified that:-
1. Member of my family and myself for whom reimbursement of fare has been claimed in
the bill actually performed the journey at my Home Town and back/any place, anywhere
in India and back.
2. My wife is not an employee of the Council/or the Central Government or that 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 or the family members for
the concerned block of two/four years.
3. The journey was actually performed by Mail/Express Train.
4. No return ticket at concessional rate was available for this journey.
5. The reimbursement of fares claimed in this bill has not been drawn by me before in any
shape or from any other source.
6. The distance for which road mileage has been claimed in the bill is correct to the best of
my knowledge.
7. I actually performed the road journey from …………………. to ………………………..

any back by the shortest route by recognized public transport.
8. The journey was performed by lower/upper class accommodation in the recognized

public transport.
DATE: (SIGNATURE OF EMPLOYEE)

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L.T.C. certificate to be given by the Controlling Officer
COUNTER SIGNED AND CERTIFIED THAT

1. The journey was actually performed for the block year ……………………………….
2. To visit any place anywhere in India i.e. ………………………………………………

(Name of Place)
3. To the declared Home Town.
4. Concession has been availed previously during the block year i.e. …………………….
(indicate year specifically).
5. Shri………………………………………………… has rendered continuous service not

than one year under Council to the date on which outward journey was performed and
will continue to serve the Council from the period of two years for the date of his/her
joining the Council.
6. Necessary entries have been made at page No. ……………….. of the service book of
Shri/Shrimati/Miss ……………………………………………………………………….
and duty countersigned on ………………………………….. date).
* In applicable part Project Officer/Officer Incharge/

may please be deleted Deputy Director (Admn.)
(Office Stamp)

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CENTRAL COUNCIL FOR RESEARCH IN AYURVEDIC SCIENCES

12. Particulars of travel such as outward:-

Cash receipts etc. from :

15. Amount of L.T.C. advance drawn if :

16. Any other information which the :

2. My wife is not an employee of the Council/or the Central Government or that my

3. The journey was actually performed by Mail/Express Train.

4. No return ticket at concessional rate was available for this journey.

7. I actually performed the road journey from …………………. to ………………………..

8. The journey was performed by lower/upper class accommodation in the recognized

DATE: (SIGNATURE OF EMPLOYEE)

L.T.C. certificate to be given by the Controlling Officer

COUNTER SIGNED AND CERTIFIED THAT

2. To visit any place anywhere in India i.e. ………………………………………………

3. To the declared Home Town.

5. Shri………………………………………………… has rendered continuous service not

* In applicable part Project Officer/Officer Incharge/

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