Indian Institute of Astrophysics

INDIAN INSTITUTE OF ASTROPHYSICS

BANGALORE-560 034

SETTLEMENT OF LEAVE TRAVEL CONCESSION BILL FOR THE BLOCK YEAR.………

1. Name (In Block Letters) :
2. Designation :
3. Present Basic Pay :
4. Place of Visit :
5. Home Town or All India :
6. Amount of Advance, if any, drawn :
7. Duration and nature of leave sanctioned :
8. Persons in respect of whom L.T.C. has been claimed :
Sl. No. / Name(s) / Age / Relationship
1.
2.
3.
4.
5.
6.
7.
8.
To be filled by the official For Official use
Mode and class of travel / Place / Date / Time / Distance
K.M / Fare
Paid Rs. / Ticket
No./s / Fare admitted Rs.
Dep :
…………………..
Arr : / …… / ……..
Dep :
…………………..
Arr : / …… / …….
Dep :
…………………..
Arr : / …… / ……..
Dep :
…………………..
Arr : / …… / …….
Dep :
………………….
Arr : / …… / …….
Carried over………
To be filled by the official For Official use
Mode and class of travel / Place / Date / Time / Distance
K.M / Fare
Paid Rs. / Ticket
No./s / Fare admitted Rs.
Dep :
…………………..
Arr : / …… / …….. / Brought forward
Dep :
…………………..
Arr : / …… / …….
Dep :
…………………..
Arr : / …… / ……..
Dep :
…………………..
Arr : / …… / …….
Total………
Less Advance Drawn
Balance

CERTIFIED THAT

i)The information as given above is true to the best of my knowledge and belief and

ii)that my husband/wife is not employed in Government service/that my husband/wife is employed in Government service and the concession has not been availed by his/her separately for himself/herself or for any of the family members for the concerned block year…………….

Dated: Signature of the Claimant

Claimed passed for Rs. (Rupees

Prepared by: SSO/AAO Accounts Officer Administrative Officer

Received Rs. (Rupees

Dated: Signature of the Claimant