•

MINISTRY OF COMMUNICATIONS
DEPARTMENT OF TELECDllORJNICATIONS
(AJ;IM.N. I.\'. SECTION) ..
.. ·.
. APJ'LICATION ..flm. _LEAVE tMVEL ci>NCESSION ADVANCE

1. N&111e of the ~Pl'lioant .,.. .

2. Designation ' ·
.....
... :.-·'-···
. , ... ·
·,.·

3. bat·e of ellte:ring the Cent-r8.l .Govt. Service : , '_···.- .

•<

4. Present Pay .
5. W_hether per1l4nent'. or Temporary :
. :·

6. HoJ!it. T~Wn af·:recorded in th~·. Servi~e Book :

. ·.- ·--. . •' ' - · .. ·:· - ·:-'.. -.--·:· ·-- :_. ,- - / - . ""~;- ._- .-_:_. __ : - ,-- . _· .. _ ··.
7. Whe.ther husband/wite.. is·employeddn Govt. . :. . '\~-, ,. ~

service or·,Jiot,.. in nas~ yes/·certi:f-icat.e

0 . I, ·.,·.
to the· et-feet th&t he/she wi.11 not: ·clailll . ' :< . • ~ ..
..~
from his/he~ Deptt. duly ensured·by the'
concerned Dep~t. may be attached.

l. Whe-ther the conces-sion is to be availed tor ..

visiting Home Town .and if so· block .for which
LTC is to be availed ·

t. a) · If the 0 0-1ce11ii~n .is t~ visit &Dyll!bere in

India, j'e place to be •!sited ..• '
. b} ii'it,:~i'·li~J';~i~·h to be. avai
. : .
i ed , ''
·-- ·,· .. ·:· ._. ' '··:·:-·;·_ ..

0, ~~arest Railway S:tationAwrite ·1n : .

capit.al
; ;- .- --·
- -
)ettersJ.
.·--. .. _- . ·
'_-· - - -

1. Dis,i~il:~. b~.t,~ee~ Ne1'.J>~Jhi ~nd the

'' •.·

Home ·Town' .
··P,f~~i·~p~lffe:.fit':{!;~t~~ ;~s .sh~w~ , in· Col {6 ~~t,:~;, ,,
z. J>ei'iod<o1';'Jeave .from· : ·
~ . ',::;:~~~-;~-'.
3. shiiii~;;iifl °rare/bus fare from the HQ to :
Boiise_,To$.d
'....... ;.,,.-.,,. ·- .-_ ·,·.:.. .. . place ,of visit
-.~-· . .

by short routes-

'. ·Pdrsons
be avai
cin res~ect of whom LTC is proposed :
to ,,·, ·. .• . ied. ... - ' _, '

I .No.· ')'1ame and Aite .Relationship with the applicant

 •• - 2
0 5. Total number
. . ;
of' ti eke ts· ~ • • •' • ••
..•
"A

16.

'
17. L!kel~ date of·coapletionof return :

jo,1rney

18. Whet~er intention to avail of the LTC .

·~ai;·b'!en intiaated in· advanc:e, if not,.

necessary formal intimation aay kindly.·

be. g-i v~n now .to Admn. IV. Section

19. Amount o! advance as req1.1ired break up·. :

of the advance · · ··

. a) Cost of the outward_ journey

b) . Cost of · th,e 'return j ourriey f o,r all
..
. '·

! ..

the. Plll'.sons
- ' ._ -'
. .

c) Totil.l<otNo.I &JI.a-hove···.. •. /.. :

d)L'l'C advance adnlissible (only 90%'of : __.__ .,_
( i .fi) above, . ·',. . ..
20. Amount or 'it~vance re'quired
- .,•. .­ ~-. ~ -~

21. Whether LTC:•was avs.iled of during the

previoui 2 I ~ years

22. Whether final bill In respect of the

previous vrc advance has been.submitted

ana· adj us t"ed . . . ·.... ~,._u_

:>.3. . · Salary dralMJ ti-om MOC./DQJ(WPC~any .Jther:
Siirnature of the.Applicant

Naae·:
Designation ;
.T.)lo .•

I .de1;1are that th.e particulars furnished above .are .true

and correct ··.to the beiq ot,111.Y knoll'l e.dc:e. ·I u.udertake ··to produce ·
the ti cl:ets tor the outward jo.urney Yi th!·.n. t~!l,;~itrs .;ot receipt of
the advance• . . .·. ... ;;~;;:;.·:·•·.

(Signature of the appl-i cant)

Date:
Particulars shown in .;oltimnsl lo s, 8, 9; 12 and 14 above veri­
~ied•
~· .-.... : -~ -·

SO(Admn.J) I II I SEA / STG-I/

STG -II / STG .-III /Pension