BILL NO DATE

LEAVE TRAVEL CONCESSION BILL

FOR THE BLOCK/CALENDAR YEAR TO

PLACE OF VISIT : PORT BLAIR, ANDAMAN AND NICOBAR ISLANDS

NEAREST RAILWAY STATION /BUS STAND :

PART – A

(TO BE FILLED BY THE GOVERNMENT SERVANT)

1. Emp. Code 2. Name Dr S V VAGEESHA

3. Designation INCHARGE CIVIL 4. Basic Pay Rs.1,81,800/= in table 13A.

(As on date of
onward journey)
5. Headquarters : DTTE, Pitampura

6. Leave Details

a) Nature of Leave EL b) Period 10.01.2020 to 18.01.2020

7. Particulars of members of family in respect of whom the LTC has been claimed

Sl.No Name Age Relationship

1 Dr. S V VAGEESHA 54 Self

2 Mrs. N SAVITHA 45 Wife

3 Ms.DEEKSHA S V 23 Daughter

4 Mr ESHWAR S V 20 Son
 8. Details of journey(s) performed by Government Servant and the members of his/her family b y A i r :

Dep. Arrival Distance Mode Class of No. of Fare Ticket PNR Remarks
Date & Date & (Kms) of Accommod fares Paid Nos Nos
ation
Place Place Travel
used
10.1.2020 10.1.2020 N/A AIR Economy 4 122328=00 H1B60
5.30 4.45
Delhi Port Blair
18.1.2020 18.1.2020 N/A AIR Economy 4 148788=00 0982132 Portblair to
Delhi Via
8.30 10.40 359851 Kolkata due
Portblair Kolkata to 54 to
18.1.2020 18.1.2020 N/A AIR Economy 4 “UNAVIALB
EL STATUS”
5.30 7.50 in Air India
Kolkata Delhi for three days
Total 271116=00

9. Amount of advance, IF ANY DRAWN Rs:- 2,20,000/=

10. Particulars of journey(s) for which higher class of accommodation than the one to
which the Government Servant is entitled was used. ( Sanction No. and date to be given) :
NOT APPLICABLE

11. Particulars of Journey(s) performed by the road/water between places connected by rail/road:

Date & Names of places Class to which Fare Paid Remarks

From To entitled
Port Blair Havelock Economy 6336=00 for four Due to non
(A& N Islands) (A &N Islands) tickets availability of
Tickets in Govt Ferry
(850/= per head)
Annexure
Havelock Neil Economy 5392=00 for four Due to non
tickets availability of
Tickets in Govt Ferry
(850/= per head)
Neil Portblair Economy 5864=00 for four Due to non
tickets availability of
Tickets in Govt Ferry
(850/= per head)
Total 17592=00 for four Reimbursement can
tickets be made on
Government rates
i.e. 850X4X3=
10200=00
Certified that : -

1. The information are given above is true to the best of my knowledge and belief

2. That my husband /wife is not employed in Government service/that my husband /wife is employed
in Government Service and the concession had not been availed of by him/her separately for
himself/herself or for any of the family members for the concerned block year to .

3. That my wife for whom LTC is claimed by me is employed in N/A (Name of the public sector
undertaking/Corporation/Autonomous Body, etc.,), which provides leave travel concession facilities but
he/she has not preferred and will not prefer any claim in this behalf to his/her employer; and

4. That my wife for whom LTC is claimed by me is not employed in any Public Sector
Undertaking / Corporation /Autonomous body financed wholly or partly by the central
government or Local body, which provides LTC facilities to its employees and their families.

5. That my father/mother/sister/brother is /are fully dependent on me and their income is less than Rs
500 /- per month and he/she/they is/are residing with me. : N/A

Dated : - Signature of Government Servant

Name Dr. S V VAGEESHA

Emp.Code

Telephone No 9868597378

Intercom No

Email vageeshashantha@gmail.com

CERTIFICATE TO BE GIVEN BY ADMINISTRATION

1.)Certified that necessary entries have been made in the service book of Shri /Smt /Kum

2.) Joint declaration/ certificate received from his/her husband’s/ wife’s office. He/She will avail
LTC and other benefits from this office.

Signature of the Officer Authorised to attest in the service book

 PART –B

(To be filled by Bill section)

1. The net entitlement an account of Leave Travel Concession works out Rs

Rupees (in words)

a) Railway/Air/Bus/ Steamer Fare Rs

b) Less Amount of advance drawn Rs

Vide Bill No

Dated Rs

Net Amount Rs

2. Expenditure is debit able to

Major head
Sub head

Drawing and Disbursing officer

(Signature)

Bill Clerk

Initial