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ApplicationformforgrantofLTCadvance

1.NameoftheGovernmentServant2.Designation3.DateofenteringtheCentralGovernmentService4.PAY+SI+NPA5.Whetherpermanentortemporary6.HomeTownasrecordedintheServiceBook7.Whetherwife/husbandisemployedandifsowhetherentitledtoLTC8.WhethertheconcessionistobeavailedforvisitinghometownandifsoblockforwhichLTCistobeavailed.9.(a)IftheconcessionistovisitanywhereinIndia,theplacetobevisited.(b)Blockforwhichtobeavailed.10.Singlerailfare/busfarefromtheheadquarterstohometown/placeofvisitby

shortestroute.11.PersonsinrespectofwhomLTCisproposedtobeavailed.S.NoNameAgeRelationship1.2.3.4.5.6.12.Amountofadvancerequired.Rs.

Ideclarethattheparticularsfurnishedabovearetrueandcorrecttothebest

ofmyknowledge.undertaketoproducetheticketsfortheoutwardjourneywithintendaysofreceiptoftheadvance.

IntheeventofcancellationofthejourneyorifIfailtoproducetheticketswithintendaysofreceiptofadvance,Iundertaketorefundtheentireadvanceinonelumpsum.

DateSignatureofGovernmentServant.

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G.A.R.14-CSubBillNo._________

LEAVETRAVELCONCESSIONBILLFORTHEBLOCKOFYEAR_____________TO_____Note:--Thisbillshouldbepreparedinduplicateoneforpaymentandtheotherasofficecopy.

PARTA(TobefilledupbyGovernmentServant)

1.NameoftheGovernmentServant2.Designation3.PAY+SI+NPA4.Headquarters5.NatureandperiodofleavesanctionedFromTo6.ParticularsofmembersoffamilyinrespectofwhomtheL.T.C.hasbeenclaimed.S.No.Name(s)AgeRelationshipwiththeGovernmentServant1.2.

3.4.5.6.7.Detailsofjourney(s)performedbyGovernmentservantandthemembersofhis/herfamily.DepartureArrivalDistanceinKmsModeofTravel&classofaccommodationused

NooffaresFairpaidRemarksDate&TimeFromDate&TimeTo8.Amountofadvance,ifany,drawnRs.

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9.Particularsofjourney(s)forwhichhigherclassofaccommodationthantheonetowhichtheGovernmentservantisentitledwasused.(SanctionNo.&Datetobegiven.)PlaceModeofconveyanceClasstowhichentitled.ClassbywhichactuallytravelledNoofFaresFarepaidFromToRs.P.10.Particularsofjourney(s)performedbyroadbetweenplacesconnectedbyrailNatureofPlaceClasstowhichentitledRailfareFromToRs.P.

Certifiedthatthe:-

1.Information,asgivenaboveistruetothebestofmyknowledgeandbelief;and2.Thatmyhusband/wifeisnotemployedinGovernmentservice/thatmyhusband/wifeisemployedingovernmentserviceandtheconcessionhasnotbeenavailedofbyhim/herseparatelyorhimself/herselforforanyofthefamilymembersoftheconcernedblockof_____________Years.Date_______________________

SignatureofGovernmentServant

PartB(tobefilledintheBillSection)

1.ThenetentitlementonaccountofleavetravelconcessionworksouttoRs._______________________asdetailedbelow:-(a)Railway/Air/Bus/SteamerfareRs._______________________________(b)LessamountofadvancedrawanvideVoucherNo______________dated__________Rs._______________________________NetAmountRs.

2.

TheexpenditureisdebitabletoInitialofBillClerkSignatureofDrawing&DisbursingOfficer

Countersigned

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SignatureofControllingOfficerCertifiedthatnecessaryentrieshavebeenmadeintheServiceBookofShri/Shrimati/Miss______________________

SignatureoftheofficerauthorizedtoattestentriesintheServiceBook.

PassedforRs..Rupees....

SignatureofControllingOfficer

FORUSEINACCOUNTSBRANCH/PAYANDACCOUNTSOFFICE

VOUCHERNODATED

PayRs..RupeesVideChequeNo.dated..

SignatureoftheDrawingandDisbursingOfficer

LTCCERTIFICATECERTIFICATESTOBEGIVENBYTHECONTROLLINGOFFICER

Certified:

(i)thatShri/Shrimati/Kumari(NameoftheGovt.Servant)Hasrenderedcontinuousserviceforoneyearormoreonthedateofcommencingtheoutwardjourney.(ii)thatnecessaryentriesasrequiredunderpara3oftheMinistryofHomeAffairsO.M.No.43/1/55-Ests.(A)PartIIdated11thOctober,1956havemadeintheServicebookofShri/Shrimati/Kumari

Signature&DesignationoftheControllingOfficer

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CERTIFICATTOBEGIVENBYTHEGOVT.SERVANT

1.IhavenotsubmittedanyotherclaimsoforLeaveTravelConcessioninrespectofmyselformyfamilymembersinr/otheblockoftheyearsand2.IhavealreadydrawnTAfortheLeaveTravelConcessioninrespectofjourneyperformedbyme/mywifewith..children.Theclaimisinrespecttothejourneyperformedbymywife/myselfwithchildrennoneofwhomtraveledwiththepartyontheearlieroccasion.3.IhavenotalreadydrawnTAfortheLeaveTravelConcessioninrespectofajourneyperformedbyme/mywifewith..children/childreninrespectoftheblockoftwoyears..and..Thisclaimisinrespectofthejourneyperformedbymywifewith..children/childrennoneofwhomavailedoftheconcessionrelatingtothatblock.4.IhavealreadydrawnTAfortheLeaveTravelConcessioninr/oajourneyperformedbymeintheyearinr/oofblockoftwo

yearsand..Thisclaimisinr/oofthejourneyperformedbymeintheyear..Thisisagainsttheconcessionadmissibleonceeveryyearinaprescribedblockforvisitinghometownasallthemembersofmyfamilyarelivingawayfromplaceofwork.5.Thejourneyhasbeenperformedbyme/mywife..children/..childrentothedeclarehometownviz6.Thatmyhusband/wifeisnotemployedinGovernment.Thatmyhusband/wifeisemployedinGovernmentServiceandtheconcessionhasnotbeen

availedofbyhim/herseparatelyforhimself/herselforforanyofthefamilymembersfortheconcernedblockoftwoyears.

7.Certifiedthatmywife/husbandforwhomL.T.C.isclaimedbymeisemployedin.(NameofthePublicSectorUndertaking/Corporation/Autonomousbodyetc.)whichprovidesLeaveTravelConcessionfacilitiesbuthe/shehasnotpreferredandwillnotprefer,anyclaiminthisbehalffromhis/heremployer.8.

Certifiedthatmywife/husbandforwhomL.T.C.isclaimedbymeisnotemployedinanyPublicSectorUndertaking/Corporation/AutonomousbodyfinancedwhollyorpartlyownedbytheCentralGovernmentLocalBodywhichprovidesL.T.Cfacilitiestoitsemployeesandtheirfamilies.SignatureofGovernmentServant

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CONVEYANCEHIRECLAIM

1.NameoftheGovernmentServant2.Designation3.Officer/Sectiontowhichattached4.DepartmentName10.Particularsofjourneyforwhichconveyanceisclaimed.DateofJourney&timeParticularsModeofconveyanceDistanceinKmsPurposeofJourneyAmountSpentinRs.DateTimeFromTo12345678

Note:-IncaseofTaxi/ScooterhiretheRegistrationNoofthevehicleshouldbequotedandfarereceiptbeenclosed.

Date____________SignatureoftheClaimant___________________________________NameandDesignationoftheClaimant_________________________

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G.A.R.14--ASubBillNo._________________

TRAVELLINGALLOWANCEBILLFORTOURNote:-Thisbillshouldbepreparedinduplicateoneforpaymentandtheotherasofficecopy

PARTA(TobefilledupbyGovernmentServant)

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Certifiedthattheinformation,asgivenabove,istruetothebestofmyknowledgeandbelief.

()SignatureoftheGovernmentServantDate____________________________

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1.CertifiedthatI/myfamilywasneitherallowedfreetransitbyRailunderfreepassorotherwiseprovidedwithmeansofcommunicationatexpenseofthestateorLocalBodiesjourneyforwhichT.A.hasbeenclaimedinthisbill.2.CertifiedthatI/myfamilyactuallytraveledbytheclassforwhichT.A.hasbeenclaimedinthisbill.3.Certifiedthatthenumberofkilometersshowninthebillisinaccordancewiththepolymaternaltablesoftheestablishment.4.Certifiedthatthejourneyon.wasperformedbyMail/Expresstrainintheintecservice.5.CertifiedthatIwasactuallynotmerelyconstructivelyincamponSundaysandholidaysforwhichdailyallowanceisclaimed.

6.CertifiedthatIwasnotabsentonCasualLeaveduringtheperiodforwhichdailyallowancehasbeenclaimed.7.Certifiedduringmyhaltat.from.towhileoninspectiondutycontinuetoincurexpenditureafterthefirst10days.8.CertifiedthatIdidnotperformtheroadjourneyforwhichthekilometerallowancehasbeenclaimedatthehigherratesrule46ofSupplementaryrulebytakingasingleseatinataxi/motororminibusorlorryplayingforhire.

9.CertifiedthatIincurredrunningexpensesinacarforwhichclaimedinthisbillforjourney.10.CertifiedthattheroadjourneysforwhichkilometerhasbeenclaimedatthehigherprescribedinSupplementaryrule46wasperformedbymyowncar.11.Certifiedthattheroadjourneysforwhichmileageisclaimedwereperformedbyroadbutwerechargedbyrail.Thenumberofkilometersactuallytraveledbyroadbeing.12.CertifiedthatthefamilymembersforwhomT.A.hasbeenclaimedactuallytravel

ledwithmeorfollowedmeontransfer.Theywerewhollydependentuponme&residingwithme.13.Certifiedthatactualexpensesincurredascostortransportationofpersonaleffectswerenotlessthanthesumclaimedinthebill.14.CertifiedthatIhavetransportedkgms.ofluggageonmytransferfrom.to..

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G.A.R.14--B[SeeRule66(1)&90(1),(I)]SubBillNo._________________

TRAVELLINGALLOWANCEBILLFORTRANSFERNote:-Thisbillshouldbepreparedinduplicateoneforpaymentandtheotherasofficecopy

PARTA(TobefilledupbyGovernmentServant)

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/.S

1.CertifiedthatI/myfamilywasneitherallowedfreetransitbyRailunderfreepassorotherwiseprovidedwithmeansofcommunicationatexpenseofthestateorLocalBodiesjourneyforwhichT.A.hasbeenclaimedinthisbill.2.CertifiedthatI/myfamilyactuallytraveledbytheclassforwhichT.A.hasbeenclaimedinthisbill.3.Certifiedthatthenumberofkilometersshowninthebillisinaccordancewiththepolymaternaltablesoftheestablishment.4.Certifiedthatthejourneyon.wasperformedbyMail/Expresstrainintheintecservice.5.CertifiedthatIwasactuallynotmerelyconstructivelyincamponSundaysandholidaysforwhichdailyallowanceisclaimed.

6.CertifiedthatIwasnotabsentonCasualLeaveduringtheperiodforwhichdailyallowancehasbeenclaimed.7.Certifiedduringmyhaltat.from.towhileoninspectiondutycontinuetoincurexpenditureafterthefirst10days.8.CertifiedthatIdidnotperformtheroadjourneyforwhichthekilometerallowancehasbeenclaimedatthehigherratesrule46ofSupplementaryrulebytakingasingleseatinataxi/motororminibusorlorryplayingforhire.

9.CertifiedthatIincurredrunningexpensesinacarforwhichclaimedinthisbillforjourney.10.CertifiedthattheroadjourneysforwhichkilometerhasbeenclaimedatthehigherprescribedinSupplementaryrule46wasperformedbymyowncar.11.Certifiedthattheroadjourneysforwhichmileageisclaimedwereperformedbyroadbutwerechargedbyrail.Thenumberofkilometersactuallytraveledbyroadbeing.12.CertifiedthatthefamilymembersforwhomT.A.hasbeenclaimedactuallytravel

ledwithmeorfollowedmeontransfer.Theywerewhollydependentuponme&residingwithme.13.Certifiedthatactualexpensesincurredascostortransportationofpersonaleffectswerenotlessthanthesumclaimedinthebill.14.CertifiedthatIhavetransportedkgms.ofluggageonmytransferfrom.to..

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PerformaforapplicationforadvancefromProvidentFundsApplicationforAdvancefromG.P.F.

1.NameoftheSubscriber2.AccountNumber3.Designation4.PayRs.5.BalanceatCreditofthesubscriberonthedateofapplicationasbelow:iClosingbalanceasperstatementfortheyear___________RsiiCreditfrom_________to___________onaccountofmonthlysubscription.RsiiiRefundsRsivWithdrawalsduringtheperiodfrom__________to_____________RsvNetbalanceatcreditRs6.Amountofadvance/outstanding,ifany,andthe7.AmountofAdvancerequired8.a.Purposeforwhichtheadvanceisrequired

bRulesunderwhichtherequestiscoveredcIfadvanceissoughtforHouseBuildingetc.,followinginformationmaybegiven:iLocation&measurementoftheplotiiWhetherplotisfreeholdoronleaseiiiPlanforconstructionivIftheflatorplotbeingpurchasedisfromaH.B.Society,thenameofSociety,thelocation&measurement,etc.vCostofconstructionviIfthepurchaseofflatisfromDDAoranyHousingBoardetc.,the

location,dimension,etc.,maybegiven.dIfadvanceisrequiredforeducationofchildren,followingdetailsmaybegiven:

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iNameoftheson/daughteriiClass&Institution/CollegewherestudyingiiiWhetheraday-scholarorahostlereIfadvanceisrequiredfortreatmentofailingfamilymembers,followingdetailsmaybegiven:iNameofthepatientandrelationshipiiNameoftheHospital/Dispensary/Doctorwherethepatientisundergoingtreatment.iiiWhetheroutdoor/indoorpatientivWhetherreimbursementavailableornot9Amountoftheconsolidatedadvance(Items6and7)andnumberofmonthlyinstallmentsinwhichtheconsolidatedadvanceisproposedtoberepaid.Rs.__________________in________Installments.10.

FullParticularsofpecuniarycircumstancesofthesubscriber,justifyingtheapplicationfortheadvance

Icertifythatparticularsgivenbelowarecorrectandcompletetothebestofmyknowledgeandbeliefandthatnothinghasbeenconcealedbyme.

Date:

SignatureoftheApplicant

Name___________________________Designation______________________Section/Branch__________________

Note:-Incaseofadvanceunder8to8(e),nocertificateordocumentaryevidencewouldberequired.

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PerformaforapplicationforwithdrawalfromProvidentFundsApplicationforAdvancefromG.P.F.

1.NameoftheSubscriber2.AccountNumber3.Designation4.PayRs.5.DateofJoiningserviceanddateofSuperannuation5.BalanceatCreditofthesubscriberonthedateofapplicationasbelow:iClosingbalanceasperstatementfortheyear___________RsiiCreditfrom_________to___________onaccountofmonthlysubscription.RsiiiRefundsmadetotheFundaftertheclosingbalance,vide(i)aboveRsivWithdrawalsduringtheperiodfrom__________to_____________Rs

vNetbalanceatcreditondateofapplicationRs6.AmountofAdvancerequired8.a.PurposeforwhichthewithdrawalisrequiredbRulesunderwhichtherequestiscovered9Whetheranywithdrawalwastakenforthesamepurposeearlier.Ifso,indicatetheamountandtheyear..10.NameofthePAOmaintainingtheProvidentFundAccount

Date:

SignatureoftheApplicantName___________________________Designation______________________

Section/Branch__________________

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Annexure-DForms1

FormofApplicationforFinalPayment/TransfertoCorporateBodies/OtherGovernmentsofBalancesintheGeneralProvidentFundAccount

To

ThePayandAccountsOfficer,_________________________,_________________________,(ThroughtheHeadofOffice)

Sir,

Iamtoretire/haveretiredhaveproceededonleavepreparatorytoretirementfor_________________________months/havebeendischarged/dismissed/havebeenpermanentlytransferredto________________________/haveresignedfinallyfrom

Governmentservice/haveresignedserviceunder___________________Governmenttotakeupappointmentwith___________andmyresignationhasbeenacceptedwitheffectfrom_________________forenoon/afternoon.Ijoinedservicewith______________on______________forenoon/afternoon.

2.MyProvidentFundAccountNo.is__________________________3.Idesiretoreceivepaymentthroughmyofficethroughthe____________________Treasury/SubTreasury.Particularsofmypersonalmarksofidentificationlefthandthumbandfingerimpressions(inthecaseofilliteratesubscribers

andspecimensignature(incaseofliteratesubscribers)induplicate,dulyattestedbyaGazettedOfficeroftheGovernment,areenclosed.PART-I[Tobefilledinwhentheapplicationforfinalpaymentissubmitteduptooneyearpriortoretirement]

4.IrequestthattheamountofRs.________________standingtothecreditinmyProvidentFundAccountasindicatedintheAccountsStatementissuedtomefortheyar___________________(enclosed)/asappearinginmyledgeraccountbeingmaintain

edbyyou_____________________________Treasury/SubTreasury/HeadofOffice,mypleasebearrangedtobepaidtomeasfirstinstallmentoffinalpayment.5.******

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6.AfterpaymentofthefirstinstallmentofmyProvidentFundbalance,IwillapplyforthepaymentofsubsequentinstallmentsinPart-IIoftheformimmediatelyonretirement.Yoursfaithfully

Signature------------------------------

Station-------------Name________________________

Date:-___________Address_____________________

ThisappliesonlywhenpaymentisnotdesiredthroughtheHeadofOffice.

(FORUSEBYHEADSOFOFFICES)

ForwardedtothePay&AccountsOfficer_________________________fornecessaryaction.

2.TheProvidentFundAccountNo.__________________ofShri/Shrimati/Kumari(ascertifiedfromtheStatementsfurnishedtohim/herfromyeartoyear)is

____________________________.3.He/SheisduetoretirefromGovernmentServiceon________________________________________________________.4.Certifiedthathe/shehadtakenthefollowingadvancesinrespectofwhich______________________instalmentofRs._____________________areyettoberecoveredandcreditedtotheFundAccount.Thedetailsofthefinalwithdrawalsgrantedtohim/herarealsoindicatedbelow:TemporaryAdvancesFinalWithdrawals

1.____________________________________________________

2.____________________________________________________

3.____________________________________________________4.____________________________________________________5.******SignatureoftheHeadofOffice

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PART-II

[TobesubmittedbytheSubscriberimmediatelyafterhis/herretirement.ThisPartisalsoapplicableinthecaseofsubscriberswhoapplyforfinalpaymentforthefirsttimeafterthedateofsuperannuation,discharge,resignationetc.]

Incontinuationofmyearlierapplication,dated___________________________,forthefinalpaymentofProvidentFundbalances,Irequestthattheentirebalanceatmycreditwithinterestdueundertherulesmaybepaidtome.

OrIrequestthattheentireamountatmycreditwithinterestdueundertherulesmaybepaidtome/transferredto____________________________________.

Signature------------------------------

Name________________________

Address_______________________

(FORUSEBYHEADSOFOFFICES)

ForwardedtothePay&AccountsOfficer_________________________fornecessaryaction/incontinuationofEndorsementNo._____________dated__________.

2.He/Shehasfinallyretired/willproceedonleavepreparatorytoretirementfor_________________________months/havebeendischarged/dismissed/havebeenpermanentlytransferredto________________________/haveresignedfinallyfrom

Governmentservice/haveresignedserviceunder___________________Governmenttotakeupappointmentwith___________andmyresignationhasbeenacceptedwitheffectfrom_________________forenoon/afternoon.He/Shejoinedservicewith______________on______________forenoon/afternoon.3.Thelastfunddeductionwasmadefromhis/herpayinthisofficebillNo._______________,dated______________,forRs.______________(Rupees___________________________),cashvoucherNo._______________of__________________Treasury,theamountofdeductionbeingRs._________________andrecoveryonaccountofrefundofadvanceRs.___________________.4.Certifiedthathe/shewasneithersanctionedanytemporyadvancenoranyfinal

withdrawalfromhis/herProvidentFundAccountduringthe12monthsimmediatelyprecedingthedateofhis/herquittingserviceunder_______________________Government/proceedingonleavepreparatorytoretirementorthereafteror

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Certifiedthatthefollowingtemporaryadvances/finalwithdrawalsweresanctionedtohim/heranddrawnfromhis/herProvidentFundAccountduringthe12monthsimmediatelyprecedingthedateofhis/herquittingserviceunder_________________________Government/proceedingonleavepreparatorytoretirementorthereafter

AmountofAdvance/withdrawalDateVouchernumber

1.____________________________________________________

2.____________________________________________________3.____________________________________________________4.____________________________________________________5.******6.Itiscertifiedthatnodemands/followingdemandsofGovernmentareduefor1

recovery.

7.Certifiedthathe/shehasnotresignedfromGovernmentservicewithpriorpermissionoftheCentralGovernmenttotakeupanappointmentinanotherDepartment

oftheCentralGovernmentorunderaStateGovernmentorunderabodycorporateownedorcontrolledbytheState2.SignatureOftheHeadofOffice/Department

1.CertificateNo.6tobefurnishedinthecaseofContributoryProvidentFundOnly.2.Pleasescoreoutifnotnecessary.

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