REQUISITION FOR LTC ADVANCE - -/E-mail ID____________

( /To Be Submitted in Triplicate)

( )/Personal Details (IN BLOCK CAPITALS):

/NAME______________________/ DESIGNATION____________________ /GAZ/NON GAZ ________

//BRANCH/SECTION________________ /PAY IN PAYBAND_____________ / GRADE PAY_______
/ /Whether Permanent/Temporary Employee_________________ ./ EMP No.______________
/Date of joining in AFHQ __________________ /Date of Retirement____________
/Hometown as per service record:______________________ ./Tel No.________________

________________________________________
Block year for which LTC applied for_____________________________________________________________________

___________________________________________________________
Block year for last availed LTC ____________________________________________________________________________

__________________________________ ( __________________________ ________________________ )

Leave applied for____________________ days from_______________________ to_________________
_________________________ _________________________
Date of Departure_________________________ Date of Return_________________________________
/ ... _________________________________
Place of visit in case of availing Hometown/All India LTC:________________________________________
./S/B A/C No. ___________________________ /Bank Name___________________________________
/IFS Code:____________________________ /MICR Code:______________________________
/ -
Details of self/family members for whom advance is required:
/Name /Relationship /Age

Detail of Advance:
() ____________________________ ________________________ /( - I/- II/- III/ )
_________________________ ( )
(a) Air/(AC-I/AC-II/AC-III class for Rail or Bus) Rs.______________________________ (One way per person)
Fare from________________________________ to ____________________________________
() / 90% ____________________________
(b) 90% of total air/rail fare as Advance : Rs.___________________

/Receipt
___________________________ (___________________________ )
Received Rs.____________________(Rupees_______________________________only)
... , /
I am aware of all the LTC Rules in this regard & hereby undertake to follow the same.
( /Signature on Revenue Stamp)
/Name:
/Designation:
/VERIFICATION BY THE ADMINISTRATIVE SECTION
,
_______________________________
Certified that I have thoroughly verified the details furnished by the applicant with his service documents and found correct. The applicant has been sanctioned leave for
_________________ days.
/ /-( )/AO, CAO/A- ( )
--- --- 201
/Officer Stamp
//CAO/FMG
.60320/// //No.60320/LTC/ADV/CAO/FMG
/SANCTION OF THE CONTROLLING OFFICER
_______________________________. / ...
/
An amount of Rs__________________________ has been sanctioned on account of LTC Advance to the above mentioned individual and the same may please be credited to
the officers salary account.

Place: New Delhi
/Date: /Sr. Admin Officer