BHARAT SANCHAR NIGAM LIMITED

(A Government of India Enterprise)

DECLARATION TO BE OBTAINED FROM RETIRING GOVERNMENT SERVANT FOR

PAYMENT OF LEAVE ENACASHMENT AMOUNT
WHEREAS the Principal General Manager,Telecom. District,B.S.N.L,
Vjayawada has consented to grant me the sum of Rs………………… (.......……. …… …………………
only) towards Leave Encashment in anticipation of the balance of ……………………days
of Earned Leave and ………. days of H.P.L. in my credit as on the last day of my service.
I hereby acknowledge that in accepting this amount I fully understand that the above
said amount of Leave Encashment due to me is subject to revision on its being found to
be excess of that to which I am entitled, depending on the actual number of days of
Earned Leave / Half Pay Leave that will stand to my credit after finalization of my
leave account on completion of formal enquiries under the rules. I promise and
declare that I have no objection to such revision.

I further promise and undertake to repay any amount paid to me in excess of that to
which I may eventually found to be entitled. I also authorize the General Manager
Telecom. District, Vijayawada to recover such amount from the Retirement Gratuity or
from the monthly pension payable to me, in case I fail to repay the same on demand.

Station :
Signature of the official
Date:
Name :

Designation:

Countersigned by controlling officer