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LTA Claim Form

This document is a Leave Travel Assistance Claim Form for employees to report travel expenses. It includes sections for personal details, journey details, total expenses, and declarations. Additionally, it outlines the financial aspects related to LTA entitlement, advances, and taxable amounts.

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harish gowda
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16 views2 pages

LTA Claim Form

This document is a Leave Travel Assistance Claim Form for employees to report travel expenses. It includes sections for personal details, journey details, total expenses, and declarations. Additionally, it outlines the financial aspects related to LTA entitlement, advances, and taxable amounts.

Uploaded by

harish gowda
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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Annexure V

Leave Travel Assistance Claim Form


Employee No. Date

Name

Department Location

Details of persons traveled:


S.No. Name of the person Relationship to the employee

Details of Journey
S.No. Date of Mode of From To Class (in Amount per
Travel Travel case of Ticket
train/
Air
travel)

Total Expenses
*Attach all the relevant bus/train/air tickets and boarding passes. Also attach original bills of other
expenses claimed.

DECLARATION

I hereby declare that the above furnished information is true to the best of my knowledge.

Signature of the Employee


Date:
For Accounts Department
1. LTA Entitlement
(p.a.) Rs. __________
2.Total LTA
Entitlement up to Rs. __________
____________
*Last year balance + current year due upto 31st March
3. LTA Advance 4.Date of Advance
(If any) Rs.__________

4. Amount Claimed Rs.__________


5.Balance LTA
[2-(3+4)] Rs.__________

Amount Exempt from Income Tax Rs. ________________

Total Taxable Amount Rs. ________________

Income Tax on Taxable Amount Rs. ________________

Signature Date

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