Payroll Department
Mumbai
LEAVE TRAVEL ASSISTANCE (“LTA”)
This is to confirm that I have spent a sum of Rs _________ (Rupees
________________ _______________________________________________ only) which
is eligible for LTA.
The details are as follows :
Dates of leave taken (from/to) : _______________________________________
Place of origin of journey : _______________________________________
Place of destination :
_______________________________________
Dates of travel :
_______________________________________
Details of persons travelled :
Relationship Journey
Name with me Dependence (Y/N) fare in
Rupees
1. Self No
2.
3.
4.
5.
6.
Total
The travel vouchers ( ) are attached herewith.
Signature: ___________________________ Personnel Number :
________________________
Name : ___________________________ Date :
________________________
Notes :
1. LTA can be claimed exempt from income-tax only in respect of two journeys
performed in a block of four calendar years. The current block of four years
is 2006 - 2009.
2. The travel cost eligible for exemption should be for the shortest route to any
place in India.
3. “Family” in relation to an individual, means -
(i) Spouse and children; and
(ii) Parents, brothers and sisters wholly or mainly dependent on the
individual.
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(For office use only)
Rs Rs
LTA reimbursed
Less : Exempt u/s 10(5) :
_________________________________________________
_________________________________________________
_________________________________________________
(
)
LTA taxable
