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UTTAR HARYANA BIJLI VITRAN NIGAM LIMITED

BLOCK YEAR 2016-19


APPLICATION FOR AVAILING OF LEAVE TRAVEL CONCESSION
UNDER NEW SCHEME AS PER STATE GOVT. LETTER
NO.13/19/2008-2SII DATED 5.2.09, ADOPTED BY THE NIGAM VIDE
MEMO NO.CH-56/UH/HR-II/G-16 DATED 10.04.09.

1. Name of the officer/ employees :

2. Post Held :

3. Date of appointment in the present


service :

4. Date of retirement :

5. Block years for which LTC/HTC is


proposed to be availed of :

6. Basic Pay :
Grade Pay :
ADA :
Total :

7. Whether wife/ husband is employed : Yes/No


i) If employed, the certificate from his/her
department regarding non availing of
this facility be enclosed.

It is certified that the Leave Travel Concession/HTC for the


Block years being claimed above was not availed of previously.

Signature of the applicant


Dated:_______________ Name
Place:-_______________ Designation:
Office of the:

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