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LFC Leave Encashment Application

This document is an application for reimbursement of 100% LFC charges on eligible fares in accordance with an internal circular. It contains details such as the applicant's name, PF number, grade, family members traveling, fare amounts, leave encashment details, and sections for recommendation and sanction. The applicant is certifying that claimed family members are solely dependent and have no independent income to qualify for reimbursement.

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Rakesh Kapoor
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906 views3 pages

LFC Leave Encashment Application

This document is an application for reimbursement of 100% LFC charges on eligible fares in accordance with an internal circular. It contains details such as the applicant's name, PF number, grade, family members traveling, fare amounts, leave encashment details, and sections for recommendation and sanction. The applicant is certifying that claimed family members are solely dependent and have no independent income to qualify for reimbursement.

Uploaded by

Rakesh Kapoor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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__________________________ Branch ( )

______________________________________________________________________________

APPLICATION FOR REIMBUSMENT OF LFC CHARGES 100% ON ELIGIBLE


FARE IN TERMS OF CIRCULAR LETTER NO.CIR/P&HRD-IR/25/2015-16 DATED
26.06.2015.

1. Name of the Official / Employee :


2. PF No :
3. Grade :
4. Designation :
5. Date of joining in the Bank :
6. Working at the Branch Since :
7. Department /Branch :
8. LFC Option : Biennial / Quadrennial
9. LFC Block Last availed :
10. Leave Encashment Last availed :
11. No of days Leave Last Encashed :
12. Current LFC Block :
13. Current Leave Encashment Block & :
No. of Days applied for (Separate application
should be produced if availing Leave Encashment)
14. Leave applied /sanctioned :
15. Fare of eligible distance by eligible class :
16. Particulars of family members with relationship age and fare :
Sl. Name Age Relationship Fare
No (To & Fro)
1
2
3
4
17. Total eligible amount :
18. Certified that the amount claimed for Rs. (Rupees Only) for
which I am eligible in terms of Circular letter above mentioned, please effect
Total amount of fares.
19. Payment by credit to my SB/ CA A/c No.:
20. Certified that the family members mentioned in column No 16 are solely
dependent on me and they do not have any independent income.

Place:
Date: Signature of
Employee / Official.

FOR OFICE USE AT BRANCH

Recommended for Sanction of Rs. (Rupees ______________________ Only)


towards LFC charges on eligible fares by eligible class wide LHO Circular
CIR/P&HRD-IR/25/2015-16 DATED 26.06.2015.

Chief Manager /
Branch Manger
Place: (Branch seal)
Date:

FOR OFFICE USE AT RBO

Sanctioned Rs…………………
(Rupees……………………………………………………….…….….…..only)

REGIONAL MANAGER.
LEAVE ENCASHMENT FORM (LFC / HTC)

The Branch Manager Date:


State Bank of India
_____________ Branch ( ).

Dear Sir,

I shall be glad if you will please encash 01 Month, Privilege Leave on my account
and debit my leave accordingly on account of LTC / HTC sanctioned by Competent
Authority.

Yours faithfully,

Name : _____________________ PF NO: _________


Grade : ________________
Branch : ________________ Br Code:

FOR OFFICE USE IN STAFF SECTION BY EMPLOYEE/OFFICIAL


Month Days Amount
Privilege Leave due
Basic Pay Rs.
as on 31.03.
Privilege Leave Special Allowance Rs.
taken during 20 - C.C.A. Rs.
Privilege Leave H.R.A. Rs.
Encashed D.A. Rs.
Balance as on Total Rs.
Date and amount Less Income Tax Rs.
Previous leave p
encashed Amount Payable Rs.
LFC/HTC block Due
Leave Encashment
bl.due

Noted in Service Sheet.

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