figanac i GARAC ‘34 fae H/Sub-bill No. 1 Ce nae srerarat arat feared fat | Leave Travel Concession Bill for the Block of ax = Year air | feopri-ga fa A whe He gras fey ga arena ola Bee A, ey fen ore a i ! | | | I \ i 1 | f NOTE: This bill should be prepared in duplicate—ane for payment and the hers as office copy | "art & (Great Heer BIT eT TAT 8) PART-A (To be filled up by Government Servant) | i seUName | 2. waDesignation 3. dawPay.... | | 4 yerertendguarers |S. vas srsern wn ware a seat | Nature & Period of leave sanctioned From... Sc, | \ Particulars of members of family in respect of whom the LTC has been claimed.i- | | | | Fz E i 6. seararm aa ge ten faa wicae-aeedl & ferry 8 2 sam fare: | | Has. oF Rune aie [ee wea THAT Paani Gon Sov let so] Peasant 7, aca afar ah swe ofan Facer gra BE Aas Foe: Details of journey(s) performed by Government servant and the mgmber of his/her family: ah ea Departure ar rival a wai [ae] & vat [waa | | weak fester | paar at | won| fared | ao 7 we [bisancein | Mode ottavel enacts | No of | ———_ lowest] Fon fxeanitie] To [eases | laconostonned | ts | RAB) al 2 1 4 5 ‘ 1 ‘ I ' | ' + I l | o ' \ v y | d as =e L a | I | | 8, fra at com ae ¢ AAmount of advance, if any drawn RS...saa tari fa ee wea os 9 8 Pee if ceatgfa aren a fae am: | Particulars of journey (s) for which higher class of accommodation than the one to which the | J | 1 Government servant is entitled was used. (Sanction No. and Date to be given):- IPF Place wean [ae at fam fae ai foe apes] ver THe ea a am ee wa we = wm Madeot | Classto. | Classtowhich | No.of] Fare Paid From To chiveyance [which entitled] actually travelled | Fares | 6/&s, WP. 1 2) $ 4 5 6 a I 1 4 | 1 | z 1 “ -4 | ape! A Soe = i | = 1 ate . | | sae { = L iI 70, WHA ge ead San aes A Ae cost Fa ' Details of journey (s) performed by road between places connected by rail a |_ rar & arvName of Place | cag at fawet Fart Ya AEVRail Fare | We To Class to which entitled wR. WP. 2 3 4 | 1 | 1 | lps ail | | 1 | | | ! = 1 Es 4 | 21 wana Pres ara & PR Certified thatthe: i 1. aude avant aatam aa atk frrare # sagen wet 1 i Information as given above is tue, thebestof my knowledge and belie I 9, RST weet wend den Set hfe BURN teeta aa Ben HE otk TAR ois fore sear eer ft Sh weet BU AAPA That myhushandwife is not employed in Gout. servicethat my husband/wife is employed in | Gan crviecand the concession has not been availed of by hirher separately of Rimselffherself or any ofthe family member for the concerned block of 1-4 : ee ae | jon. Servant |aaa Reagan d wr amr) PART-B (To be filled inthe Bill Section) 1 eR ye vent 30 wi fret Sat TS fea Te A ‘The net entitelment on account of Leave Travel Concession works out to % Rs. .... ast | I | ' I 1 1 | I 1 1 1 | as detailed below : evergreen TE (a) Railway/air/ous/steamer fare Rs. & Rs. ; (@) Faget ng afm sam, ga oT we .. aera (b). Less amount of advance drawn vide aie No. .. soe Dated... . %& Rs. tt AAW/Net amount doce Q i faeartia bh (2) The expenditure is debitable to er ates & sree mers site ifs ferent & ere Initials of Bill Clerk Signature of Drawing & Disbursing Officer aferaraa Countersigned rine aftert % Teer Signature of Controlling Officer vata fra ara t fe Rar-gfecen A aveere wfafedt a et ge stoietergrt. Certified that the necessary entries have been made in the Service Book of Shri/Shrimati/Miss Ben yer fahedt a eaten we HA aA Frey ifead B eTEAT ‘Signature of the Officer authorised to attest entries in the Service Book | I 1 1 1 1 1 | | 1 | 1 i ! I | 1 | 1 1 | | | | | 1 | 1 | | | 1 | \ | 1 1 i ! | | | | | IS Ee AS@ coy LIC. CERTIFICATE CERTIFICATE TO BE GIVEN BY THE CONTROLLIN Certified that Sh/Smt/Ms. (Name of the Govt servant) has rendered continuous service for one year or more on the date of commencing the outward journey. Certitied that nécessary entries as required under Para 3 of the Ministry of Home Affairs O.M. No. 43/1/55-Ests.(A) part Il, dated 1 1th October, 19.56 have been made in the Service Book of Sh./Smit. Marana Signature & Designation of the Controlling Officer CERTIFICATE TO BE GIVEN BY THE GOVERNMENT SERVANT. have not submitted any other claim so far for Leave Travel Concession in respect of niyself or my family members in respect of block of two years 20, sven and 20. Thave already drawn T.A. for the Leave Travel Concession in respect of a journey performed by me/ my wife with .. children. Thave not alresciy drawn T.A. for the Leave Travel Concession in respect of a journey performed by me/my wife with. » Children MY ..e0neuefamily members in respect of block of two years 20... and 20. Ihave already drawn T.A. for the Leave Travel Concession in respect of a journey performed by me inthe year... « inrespect of block of two years 20. and20, This claimisinrespectofajourney performed by me nthe years. ‘This is against the concession admissible once every year in a prescribed block for visiting home town as all the members of my family are living away from place of work. This journey has been performed by ine with my wite with soe Childrenmny family members to the declased home town viz. ‘That my husband/wite is not employed in the Government. ‘That my husband/witeis employed inthe Government service and the concession hus not been availed of by hinvher separately for himself/herself or for any of the family members for the concerned block of two years Certified that my wite/nusbs nd for whomL. T.C.isclaimed by me isemployedin oe (Name of the Public Sec tor Undertaking/Corporation/Autonomous body” etc.) which provides Leave ‘Travel Concession facilities but he/she has nor preferred and will not prefer any claim in this behalf to hishher employer. Certified that my wifeflusband for whomL. T.C. isclaimed by meis not employed in ny Public Sector Undertaking/Corporation/ Autonomous body etc., financed wholly or partly by the Central Govern- ‘ment or Local Body which provides L:T.C. facilities to its employees and their families Signature of the Govt. servant ‘| 1 | | i | ! | | | | | | i i | 1 1 1 1 1 1 1 I | I | | 1 1 ! 1 1 | | | | | | 1 | | | 1 1 | | | | | 1 1 | 1 | | | al