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LTA Claim Form

The document is a leave travel allowance form containing fields for an employee's name, code, designation, company name, claim period, passenger and travel details including name, relationship, dates of departure and arrival, kilometers traveled, mode of travel and class, amount claimed, and a signature field.

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venkatesh8919ch
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43 views1 page

LTA Claim Form

The document is a leave travel allowance form containing fields for an employee's name, code, designation, company name, claim period, passenger and travel details including name, relationship, dates of departure and arrival, kilometers traveled, mode of travel and class, amount claimed, and a signature field.

Uploaded by

venkatesh8919ch
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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LEAVE TRAVEL ALLOWANCE FORM

NAME : EMP. CODE :

DESIGNATION : COMPANY NAME :

CLAIM PERIOD: FROM : TO :

PASSENGER and TRAVEL detail:


NAME RELATIONSHIP DATE OF PLACE OF DATE OF PLACE OF KMS MODE / AMOUNT REMARKS
WITH DEPARTURE DEPARTURE ARRIVAL ARRIVAL TRAVEL CLASS OF in RUPEES
EMPLOYEE LED TRAVEL

Important Note: Please attached original travel tickets and bills as applicable.

I hereby certify and confirm that only I …………………………………………………………………….. will be availing


the tax benefit as per the Income Tax laws applicable for claiming LTA reimbursement and that my spouse will
not be claiming any such reimbursements or tax benefit for the said block period.

Signature of Employee: Date :

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