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Application Form For LTC Advance

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APPLICATION FOR GRANT OF LTC ADVANCE

1. Name of the Govt. servant :


2. Designation :
3. Date of entering the central Govt servant :
4. Pay :
5. Whether permenant or temporary :
6. Home town as recorded in the service book :
7. Whether wife/husband is employed and if so
whether entitled to LTC :
8. Whether the concession is to be availed for :
visiting home town, and if so block for which
LTC is to be availed. :
9. (a) If the concession is to visit ‘anywhere in
India, the place to be visited. :
(b) BLOCK for which to be availed :
10. Single railfare/ bus fare from the headquarters
to home town/ place of visit by shortest route:
11. Persons in respect of whom LTC is proposed
to be availed :

Sl Name and Age Relationship

12. Period of leave applied. :


13. Amount of Advance Required :

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 out ward journey within ten days of
receipt of the advance. In the event of cancellation of the journey or if I fail to produce
within ten days of receipt of advance, I undertake to refund the entire advance in one
lump sum.

Signature of the Applicant


PART II
(To be filled by the Head of office)

Certified that the particulars furnished by the applicant against item2,3,and 5 of part I are
correct.

Signature of Postmaster.

PART III
(To be filled by HPO)

1. Particulars of previous 4 years LTC/ advance :


Taken since block period.
2. Whether advance was used for performing
Journey :
3. If not, how the advance was adjusted :

4. Any amount of previous advance remaining


to be adjusted. :

Signature of Postmaster.

PART IV

(ORDERS OF THE SANCTIONING AUTHORITY)

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