CERTIFICATE TO BE GIVEN BY THE GOVERNMENT SERVANT

--------------------------------------------------------
1. I have not submitted any other claim sofar for leave travel
concession in respect of my self or my family members in resect

of the block of the years and

2. I have already drawn T.A. for the leave travel concession

in respect of a journey performed by me/my wife with children.
This claim is in respect of the journey performed by my wife/

my self with ----------------children none of whom traveled

with the party on the earlier occasion.

3. I have not already drawn T.A. for the Leave Travel concession
in respect of a journey performed by me/my wife with............

children/---------------childran in respect of the block of

two years -----------and ------------------. This claim is in

respect of the journey performed by me wife/my self with

----------------------childran/---------------childran none
of whom availed of the concession relating to that block.

4. I have already drawn T.A. for the leave Travel concession

in respect of a journey performed by me in the year...........

in respect of a block of top years ...........and ............

This claim is in respect of the journey performed by me in the

year ............. This is against the concession admissible

once every year in prescribed block for visting hometown as
all the members of my family are lieving away from my place
of work.

5. The journey has been performed by me/my wife with .......

children/----------children to the declared hometown.

viz.................

6. That my husband/wife is not employed in Government service

That my husband/wife is employed in Government service and
the concession has not been availed of by him/her separately
for himself/hereself or for any of the family members for the
concerned block of two years.

Signature of the Government servant

 CERTIFICATE
-----------
Certify that:-
1. A Saving of Rs.-----------------has been made in the Railway
fare in this bill on account of use of free Railway pass.
2. The claims representing amount of Railway fare are for the
class of accommodation actually used.
3. I was actually and not merely constructively in camp or dates
which daily allowance has been claimed at the time of half.
4. I actually performed the journey by mail/Express trains as
such fresh have claimed at the mail/Express Trains.
5. I did not perform the journey for which mileage allowances
has been claimed at higher rates prescribed in Rule 45of the
supply . Rules by taking a single seat in any public conveyance
which place in regularly for hire between fixes points and for
fixed rates. I also certify that the journey was not performed
in any other vehicles without payment of it here incurring
expensed.
6. The Departmental tracks have not been used for Road journey
indicated in this bill.
7. The places for which road mileage in claimed are note
connected by rail.
8. A actually traveled by Road from -----------------------
to and back out but claimed by road.
9. I was not treated as state quest during my half at boarding
and lodging only at state expenses/at the expensed of the
Govt. of India or an authommonous industrial or commercial under
taking or-cooperation or a station or body or a local authority on
which Govt. funds have been invested or in which Govt. have only
other time.
10. A veiled my self/did not avail of credit facilities or
booking any Air passage with the Indian Airlines corporation
Air India international by requisition through an exchange order.
11. I stayed from ---------------------------------------------
at---------------------to---------------------------------------
which provides and lodging at scheduled tariffs.
12. All I.R./V.R. have been submitted.

Signature & Designation

 TRANSFER T.A. CERTIFICATES
------------------------------------

CERTIFIED THAT:-
----------------
1. Certified that the distances by road for road mileage
allowance have been claimed in this is correct to the
best of my knowledge and belief and the places are not
connected by rail.
2. Certified that the said journey were performed in the interest
of public service and no Govt. transport was utilised for
journeys for with road mileage allowance has been claimed.

3. Certified that my family consisting of my wife -------------

daughters age--------sons aged------------------parents,

sisters-------------- are residing with and wholly dependent

on me accompanied me on transfer.

4. Certified that personal effects weighting------------------

was were actually transferred by me from ----------------to

------------------on the occasion of my transfer in -------

and that the expenditure incurred the refer was not less
than the sum claimed herewith.

5. Certified that I have performed the journey by Bus and

Actual Bus fare has been claimed here in and Departmental
work has not been issued by me in the said journey.

6. Certified that the said journey has been performed in the

interest of public service.

7. I have taken advance Rs. ---------------.

DATE :- ----------------
Name & Designation of the
Govt. Servant.
Place:- ---------------