Bill NO. IAPT LEAVE TRAVEL CONCESSION BILL. PART- A (TO BE FILLED UP BY OFFICERS ) (1) Personal No, (2) Rank, in (3) Name. (4) CDA(O) A/C NO, 1-5) Unit (6) Duty Station (6A) LEAVE STATION / HOME STATION (7) Nature of leave sanctioned. (8) Period of leave from to (9) Particulars of men bers of family (As recorded in Service Documents ) in respect of whom the LTC has been claimed. No | Name Age_[_ Relationship wih the officer (10) Leave Travel Concession is under the provisions of RUE... ¥ Travel Regulations. (* Mention Rule including Sub-clause of 177 (A) /177 (B)/177 (C) 178/180), Details of journey's performed by the officer and the members of his / her family Departure [Arrival Mode of Traveli& Jase, gel TOt| a smoune | Warrant | je Date &| yyy [Pate | 1, [rime | lass of reo aie] Amu | / From | NER Remarks time | FO" | time | T° laccommoda paid 'D'No tion used. ONWARD, JOURNEY, I I RETURN i JOURNEY | I | t I | [Total - Amount claimed Rs. Less : Advance drawn Rs, Balance Rs. Station Received Payment Signature of Officer. Date ( Revenue Stamp ) 13. Centified that the |. Information, as given above is true to the best of my knowledge and 2. Thave not availed similar LC previously under Rule 177(A) / 177(B) / 177(C) for the block year during the year ..onsrnom FOF myself or other dependent members of the family to whom LTC is claimed in this 3. That my children / parents / sisters / minor brother to whom LTC is claimed are wholly dependent on me and are residing with me and their income from all sources ( including pension ) does not exceed Rs.1500/- per month, 4. That the journey was performed by rll C1488 smsen Vide LeketS NO eco sunee ding the onward journey and in class .......2 during the return journey vide tickets No. 5. The Home station as recorded in my service document is and the nearest railway station is Signature of the Officer: NOTES: (a) I warrant / Form 'D’ is used No, & Date of Warrant / Form 'D’ and Rly. Ticket No. should be specified (b) IF the journey is performed by air /bus then air tickets / bus tickets etc. should be attached (©) Where the journey is performed by a mode of travel other than by rail and when the officer is not in a Position to produce proof of expenditure i.., air tickets / bus tickets etc. the production of the same should be got waived by the Controlling Officer as mentioned in Apex. II TR, However, ticket numbers should be furnished. (4) Where a leave journey commences by the officer or his family members from a station other than duty station the reasons should be sufficiently explained.(©) Where the cost of leave warrant under Rule 177 (A) of 177 (B) or 177 (C) TR is claimed. The claim fon this account is to be supported by the sanction of the Control ling Officers under the above rules read with 471) TR (8) Where LTC is claimed under Rule 177 (C) TR the officer shoul id indicate whether his family (ie, wife and children ) is residing at that station where he is a ing his LTC. Place COUNTERSIGNED AS FACTUALLY CORRECT CLAIM Date: Signature & Designi of countersigning Authority