.

DATE:………………………

NAME:……………………………………….

CODE:……………………………………….

DESIGNATION :……………………………

DEPTT……………………………………….

COST CENTRE……………………………..

TO

ACCOUNTS DEPTT.

I hereby , declare and confirm having spent the same for the Leave Travel Concession
for the Calander year-------------------

MODE OF DATE OF
VISIT JOURNEY JOURNEY FARE
S.NO. TICKET NO/PNR NO FROM TO AMOUNT

TOTAL Rs

LIST OF THE SELF & DEPENDENTS WHO VISITED ABOVE STATION(S)

RELATION WITH
S.NO. NAME AGE EMPLOYEE REMARKS

I was on Leave/Holiday/Absent from work place during this travel period I.e. from………… to………………….

I am claiming LTC without supports with full

knowledge that the same is taxable.

(SIGNATURE OF THE EMPLOYEE) (SIGNATURE OF THE EMPLOYEE)

Enclosures: Photocopies of Train/Air tickets & boarding passes for air travel. Alternatively to claim taxable,
pl. sign on the declaration on above (right side).

PASSED FOR Rs……………

LEAVE/ABSENCE VERIFIED

1. HOLIDAYS ------------------------(DATES & MONTHS)

VERIFIED FOR T.D.S. ASPECTS
2. LEAVES -------------------------(DATES & MONTHS)

VERIFIED
TIME OFFICE (SIGNATURE OF ACCOUNTS DEPTT.)
FROM: DATE:…01-12-08…

NAME:…Rajesh Kumar

CODE:…17173

DESIGNATION :…Dy. Manager…

DEPTT…Powertrain MUV

TO

ACCOUNTS DEPTT.

I hereby , declare and confirm having spent the same for the purposes therein for the month of----Nov. 2008---------

1 TRANSPORT ALLOWANCE(AS PERL GIVEN BELOW) RS………………..

2 MEAL SUBSIDY RS………………..

3 UNIFORM WASHING EXPENSES RS……………..

4 MEDICAL EXPENSES(AS PER DETAIL GIVEN BELOW) RS………………..

5 TELEPHONE EXPENSES(LANDLINE) RS………………..

6 CONVEYANCE EXPENSES(ADDL) RS………………..

7 VEHICLE MAINTENANCE EXPS. RS……………..

8 DRIVER SALARY RS………………..

TOTAL RS………………….

TRANSPORT ALLOWANCE(5651)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)

TOTAL RS.
MEALS SUBSIDY(5647)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)

TOTAL RS.
MEDICAL EXPENSES(5425)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)

TOTAL RS.
VEHICLE MAINTENANCE (5450)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)

TOTAL RS.

(SIGNATURE OF THE EMPLOYEE) VERIFIED

Rajesh Kumar (SIGNATURE OF ACCOUNTS DEPTT.)
E code-17173
. DATE:………………………

NAME:……………………………………….

CODE:……………………………………….

DESIGNATION :……………………………

DEPTT……………………………………….

COST CENTRE……………………………..

TO

ACCOUNTS DEPTT.

I hereby , declare and confirm having spent the same for the Leave Travel Concession
for the Calander year-------------------

MODE OF DATE OF
VISIT JOURNEY JOURNEY FARE
S.NO. TICKET NO/PNR NO FROM TO AMOUNT

TOTAL Rs

LIST OF THE SELF & DEPENDENTS WHO VISITED ABOVE STATION(S)

RELATION WITH
S.NO. NAME AGE EMPLOYEE REMARKS

I was on Leave/Holiday/Absent from work place during this travel period I.e. from………… to………………….

(SIGNATURE OF THE EMPLOYEE)

Enclosures: Photocopies of Train/Air tickets & boarding passes for air travel

PASSED FOR Rs……………

LEAVE/ABSENCE VERIFIED

1. HOLIDAYS ------------------------(DATES & MONTHS)

VERIFIED FOR T.D.S. ASPECTS
2. LEAVES -------------------------(DATES & MONTHS)

VERIFIED
TIME OFFICE (SIGNATURE OF ACCOUNTS DEPTT.)
FROM: DATE:…01-12-08…

NAME:…Navin Yadav

CODE:…16603

DESIGNATION :…Astt. Manager…

DEPTT…Powertrain MUV

TO

ACCOUNTS DEPTT.

I hereby , declare and confirm having spent the same for the purposes therein for the month of----Nov. 2008---------

1 TRANSPORT ALLOWANCE(AS PERL GIVEN BELOW) RS…2300……………..

2 MEAL SUBSIDY RS…2500……………..

3 UNIFORM WASHING EXPENSES RS…500…………..

4 MEDICAL EXPENSES(AS PER DETAIL GIVEN BELOW) RS…1250……………..

5 TELEPHONE EXPENSES(LANDLINE) RS………………..

6 CONVEYANCE EXPENSES(ADDL) RS…750……………..

7 VEHICLE MAINTENANCE EXPS. RS…500…………..

8 DRIVER SALARY RS………………..

TOTAL RS…7800……………….

TRANSPORT ALLOWANCE(5651)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)
1 motor sprit 7219',6963 02',&22 nov 2530
TOTAL RS. 2530
MEALS SUBSIDY(5647)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)
1 sugar,rice,r-oil, ghee 3,652 25-Nov 4190
TOTAL RS. 4190
MEDICAL EXPENSES(5425)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)
1 inj.Ferty sirup,protix, 8975 11/20/2008 1605

TOTAL RS. 1605

VEHICLE MAINTENANCE (5450)
SR.NO. PARTICULARS CM/BILL NO. BILL DATE AMOUNT(IN RS.)
1 engine oil,fitting 1255 12-Nov 550
& servicing etc
TOTAL RS. 550

(SIGNATURE OF THE EMPLOYEE) VERIFIED

Navin Yadav (SIGNATURE OF ACCOUNTS DEPTT.)
E code-16603