Leave Travel Concession (LTC) Cash Voucher Scheme 2020 Application Form

Application Form for Special Cash Package in Lieu of LTC

LTC Fare + 10 Days EL Encashment

During Block Year 2018-21

1. Name / Designation of the Government Servant:
2. Date of entering the Government Service:
3. Basic Pay: Rs.
4. Pay Matrix Level:
5. Whether Permanent of Temporary:
6. Home Town as recorded in Service Book:
7. Whether wife / Husband is employed And if so whether entitled to LTC:
8. Whether the concession is to be surrendered for visiting Home-Town, and if so block year
9. If the concession is to be surrendered “anywhere in India” Block year proposed to be surrendered:
10. Single Deemed LTC fare:
11. Whether advance is required: Yes / No
12. Persons in respect of whom LTC is proposed to be availed:

I declare that the particulars furnished above are true and correct to the best of my knowledge. I undertake to produce the receipts towards the purchase or availing goods and services which carry a GST rate of not less than 120/0 from GST registered Vendors/ Service providers through digital mode indicating clearly the GST number and the amount of GST paid.

In the event of cancellation of the application or if I fail to produce the valid receipts within the stipulated time frame, I understand to refund the entire advance in one lump sum along with penal interest as applicable.

Name of the Bank:

Saving Bank Account No.:

IFSC Code:

Branch MICR Code:

Date:

Signature:

Name:

Designation:

LTC Cash Voucher Scheme 2020 Application Form PDF Download Here