APPLICATION FOR ADVANCE OF LEAVE TRAVEL CONCESSION
FOR THE BLOCK YEAR: ______________
1. Name and Designation and Service Book :
No.
2. Whether Permanent/Q.P./Temp. ? (If :
temp. the date of joining into service)
3. Pay of the Government Servant :
4. The block years for which advance is :
applied for? (Home town/anywhere in
India)
5. Amount of advance applied for (Details :
to be shown separately)
6. Name of the selected place of :
visit/home town
7. Details of family members availing LTC. :
Age and relationship may be furnished.
Declaration in respect of dependents to
be enclosed including self
8. Leave sanction particulars for availing :
LTC
9. Particulars of LTC availed previously :
10. Whether spouse is employed? (if so, :
non-availability of LTC certificate from
the employer of the spouse to be
enclosed)
11.
Station : Hyderabad Signature of the applicant
Date : Designation :
Section :
DECLARATION
I ______________ hereby declare that Shri _______________
and/or Smt ____________________ my father/mother/sister/brother
respectively is/are wholly dependant upon me and that he/she is/are
normally residing with me and that his/her/their total annual income is
` ______ (Rupees_________________________________ only).
SIGNATURE OF THE GOVT. SERVANT
