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NA VODA YA VIDY ALA YA SAMITI
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Ministry of HRD. Deptt. of School Education & Literacy
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Regional Office, Boring Road, Patna - 13
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Application Form for grant of LTC advance
1. \(i"<¢I{l Wfcp cf> ~
---------------------------------
Name of the Govt. Servant
2. ~ _
Designation
3. ~ if 1I1~IGI'1
ctr ~ --------------------------------
Date of entering the Central Govt. Service
4. ~ +~ twf +~ ~ _
Pay + DP + DA
5. ~~m3R~
------------------------------------
Whether peOrmanent or temporary
6. ~ ~Rf1¢1 if Gcl '!6 \iRLIG CfiT~ _
Home Town as recorded in the Service Book
Whether wife/husband is employed and if so whether entitled 'to LTC
8. ~ ~ lJ:5 \iRLIG cf> ~ ~ aT etA xfr ~ ~ _
Whether the concession is to be availed for visiting home town, and if so
block for which LTC is to be availed
If the concession is to visit "anywhere in India", the place to be visited
(b)~ ~ ~ ~ ~ ~ _
Block for which is to be availed
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Single rail fare/bus fare from the headquarters to home town/place of visit
by shortest route
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~ (Persons in respect of whom LTC is proposed to be availed):
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S.No. Name and age Relationship
1.
3.
4.
5.
6.
12. ~ ¢t Xlfir ~o _
Amount of advance required
13. ~ ¢t ~ ~ ~-------------
Nature & Period of Leave
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I declare that the particular 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 ten days of receipt of advance, I undertake to refund the entire advance in
on lump sum.
~(Date): ~ (Signature)
"GIlq~ (CHECK-USn
(q;14icl4 ~ ~ §g)
(For use in office)
1. m."ff. 1 ~ 6 ('j""qJ ¢t fclcRutt '{klllRld I
Particular in Cols 1 to 6 verified.
2. ~ ¢t XTftr ~O ~ ~ ~ (~
~ ¢t x=Rsm) I
Amount entitled for Fare Rs. (No. of reimbursement.
tickets).
3. WJtR ¢t t<l1¢la Xlfir (~. "'{i". 2 cnr 90 ~) I
Advance admissible (90% of amount in 2).
~O WJtR ~ fcl:>m "\J1T"fICPdT ~ I
Advance of Rs. may be sanctioned.
~.~ ~~(fctm)
D.A. Section Officer (Fin)
OiQ)GlI faEllclll 't1~RI
Navodaya Vidya/aya Samiti
(1lAq ~ fct"q;-m ~)
(Ministry of Human Resource Development)
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Deptt. of School Education & Literacy, (Govt. of India)
e):.fm Q;1l4fcll4, ~~, -qc;rr - 13
REGIONAL OFFICE, BORING ROAD, PATNA -13
~ /Ph.no 0612 .2266558/2273805
i
Fax - 0612.2266085
===~==================================================
, ==================================================================
Application for obtaining permission to avail LTC facility
1. Name of the Employee
2. Designation and Name of JNV
3. Date of entering the Service
4. Present pay
5. Whether permanent or temporary
6. Hometown as recorded in the service Book
7. Whether wife/husband is employed and if so whether entitled to L.T.C
8. Whether the concession is to be availed for visiting Hometown, and
if so block for which L.T.C is to be availed
9. (a) If the concession is to visit "Anywhere in India", the place to be visited : _
(b) Block for which to be availed
10. Persons in respect of whom L.T. C is proposed to be availed
Name Age Relationship
l.
2.
3.
4.
6.
11. Details of leave proposed to avail/vacation
12. Proposed date of onward journey
13. Proposed date of return journey
14. Signature of Applicant
