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LTA Form

This document is a Leave Travel Assistance Form for employees to claim travel expenses incurred during their leave. It requires details such as the employee's name, designation, branch, travel dates, mode of transport, and the amount claimed. The form also includes sections for declarations and office use to verify and sanction the claim.

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chc-ranchi
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34 views1 page

LTA Form

This document is a Leave Travel Assistance Form for employees to claim travel expenses incurred during their leave. It requires details such as the employee's name, designation, branch, travel dates, mode of transport, and the amount claimed. The form also includes sections for declarations and office use to verify and sanction the claim.

Uploaded by

chc-ranchi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form No:- QFAC33

Leave Travel Assistance Form


F.Y. _______________

Name of eligible Employee : _____________________________


Designation : _____________________________
Branch : _____________________________
Date of joining : _____________________________
Date of Confirmation : _____________________________
Eligible Amount : _____________________________

Is the claim for expenses (1) Self


incurred on self or for (2) Immediate family members
immediate family Members (3) Both 1 & 2 .
In case the expenses is incurred on immediate family members ,
Indicate relationship to employee : -
1._____________, 2.____________,3_____________

Date of travel From ________________to________________


Mode of Transport
(Please specify whether by
Air, Road or Railway or all )
Amount of Claim( Supported Rs._______________________
by the bills)
Declaration by the Employee I am making this claim strictly as per the provisions of the “Leave
Travel Assistance Scheme ” of the Company and declare that I
have incurred the travel expenses during my leave
Date of Claim _____________________20______

Claimant’s Signature _____________________________

FOR OFFICE USE ONLY


Claim Checked for
Correctness by _______________________________________________
Claim amount sanctioned Rs. ____________________________________________
Sanctioned by. Mr. ____________________________________________
Sign.___________________________________________
Mode of Payment Cheque
Cheque No------------- dated -------------- of ---------------
The amount Exempted /Not exempted under provisions of Income
Tax act 1961
Reasons for the same:-

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