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Sub Bill No. LEAVE TRAVEL CONCESSION BILL GAR-14c
for the block of Year [(See Rule 66 (1) & 90 (1) (i)]

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Note : This bill should be prepared iri duplicate-one for payment and the other as office copy.

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PART-A (To be filled up by Government servant)
I.;rm Name
2. vRm Designation
3. &T;r Pay
4. Head-quarters
5.**7l$@***d~ TI ..........................................?m; ............................
Nature and period of leave sanctioned From ......................................To. .............................
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Particulars of members of family in respect of whom the L.T.C. has been claimed

5.G. 3T4 T d*+t~

SI. No. Name Age Relationship with the Government servent

Details of journey (s) performed by the Government servants and the members of hislher family.

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Mode of Travel &

time
Date &
Departure

I Date &
time
Arrival
To / Distance
in Kms. Class of Accommodation
used
No.
of fares Fare Paid Remarks
8. F ? T T $ s r ~ m ? ? V k l d % * $
Amount of advance, if any drawn

Particulars of journey(s) for which higher class of accornmodation that the one to which the Government servant is
entitled, was used. (Sanctioned No. & Date to be given).
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+
Place
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m
Mode of
w-3
Class to which
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Class by which
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No. of fares
F. h 1
Fare Paid
~ ~~

From To Conveyance entitled actually travelled Rs. I P.

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Particulars of journey(s) performed by Road between places connected by rail.

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Name of Place Class of which Rail Fare
From To entitled Rs.

I I I

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Certified that the
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Information, as given above is true to the best of my knowledge and belief and
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That my husbandwife is not employed in Govemment servicelthat my husbandwife is employed in Govemment service
and the concession has been availed of himlher separately or himself or for any of the family members for the concerned
block of year.

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Dated..................
~~*~~
Signature of Government Servant
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PART-B (T-,
be filled in the Bill Section)

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The net entitlement on account of leave travel concession works out to Rs. as detailed below :-

(F)k m m & ;713 F.

(a) Railway/Air/Bus Steamer fare Rs. -

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(b) Less amount of advance drawn vide voueher No. Dated Rs. -

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Nel amount Rs.

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The expenditure is debitable to Initials of Bill Clerk

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Signature of Drawing 8 Disbursing Officer
Countersigned

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Signature of Controlling Officer.

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Certified that necessary entries have been rnade in the Service Book of Shr'iShrimati/Miss

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Signature of the Officer
authorised to attest entires in the Service Book