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Lta Declaration Form

This document is an exemption form for leave travel assistance. It collects information such as the employee name and code, travel period, destination, mode of travel, number of family members traveling, and actual expenses. The employee declares that the leave period was approved and the travel details provided are true. It notes that LTA exemption can only be claimed for one journey per financial year and proofs of travel such as e-tickets or bills are required depending on the mode of transportation.

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Rakshitha Bangera
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784 views1 page

Lta Declaration Form

This document is an exemption form for leave travel assistance. It collects information such as the employee name and code, travel period, destination, mode of travel, number of family members traveling, and actual expenses. The employee declares that the leave period was approved and the travel details provided are true. It notes that LTA exemption can only be claimed for one journey per financial year and proofs of travel such as e-tickets or bills are required depending on the mode of transportation.

Uploaded by

Rakshitha Bangera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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LEAVE TRAVEL ASSISTANCE - EXEMPTION FORM

Employee Name 0 Company Name 0

Employee Code 0 PAN No. 0 Location 0

1. Period of leave : From To

2. Final destination of journey : From To

3. Mode of Travel : Air Rail Others


(Please tick whichever applicable)

4. Single journey fare to place of trav :

5. No. of Family members accompany :

6. Total of actual expenses on fare :


to final destination and back -

I hereby declare that the particulars furnished in the above L.T.A. form are true and correct and confirm that the
period of leave mentioned above has been sanctioned by my Department Head and debited to my Privilege Leave

Place:
Date: Signature of Employee

DETAILS OF ACTUAL EXPENDITURE ON LEAVE TRAVEL ASSISTANCE


Age Relation Traveling Distance in Mode of Air / Rail / Bus Ticket Fare Rs.
Name
From To Kms. Travel No.

Total -

Notes : -

1. LTA exemption should be claimed for only one journey during the financial year

2. If the journey is performed by Airways, e-ticket or boarding pass for both sides of travel issued by the airlines
should be enclosed.

3. If the journey is performed by Railways, e-ticket or copy of rail ticket for both sides of travel should be enclosed.

4. If the journey is performed by Roadways, the original bill of the transport agency should clearly
mention whether the journey was by AC / Non-AC car, the kilometers travelled and the rate per kilometer.

5. Bills of Authorized / Reputed Travel agents will be considered for exemption.

6. Proofs submitted for foreign travel will not be considered for exemption

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