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Application For Grant of LTC Advance

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APPLICATION FOR GRANT OF LTC ADVANCE

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Name
Designation
Date of entering in Central Government
Service
Pay + SI + NPA
Whether Permanent or Temporary
Home town address as recorded in the
Service Book
Whether Wife/husband is employed and
if so whether entitled to LTC
Whether the concession is to avail for
visiting home town and if so block for
which LTC is to be availed
(a) If the concession is to visit anywhere
in India, the place to be visited
(b) Block for which to be availed
Single rail fare/Bus fare from the
headquarters to hometown/place of visit
by shortest route
Persons in respect of whom LTC is
proposed to be availed

Sl.No.

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:
:
:
:
:
:

Name & Age

Relationship

Nature of leave no. of days and date of :


commencement of leave
Amount of Advance required (Rs)
:
I declare that the particulars furnished above are true and correct to the best of my

knowledge, I undertake to produce the tickets for the outward journey 10 days of receipt of
the advance.
In the event of cancellation of journey or if I fail to produce the tickets within 10 days
of receipt of advance, I undertake to refund the entire advance in one lump sum.
Date:
Signature of the applicant
Name (In block letter):
Designation:
O/O CGMT,NE-II CIRCLE

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