Proforma for self-certification by the Government employee – Procedure of Processing of LTC claims
Proforma for self-certification by the Government employee
I Sh./Smt./Kr.
.................................................................(Name
of the Govt. servant) wish to confirm that I am availing
.............................................. (Home Town/ Any Place in
India) LTC in respect of self/ family member(s) for the block year
............................... to visit (Place of visit) during
.................. (dates of journey). It is stated that I or the family
member for whom I wish to avail LTC has/have not availed of the same
before in the present block.
2. The Particulars of members of family in respect of whom the Leave Travel Concession is being claimed are as under:
| S.no | Name(s) | Age | Relationship with the Govt. servant |
| . | . . |
3. It is certified that the above facts are true and any false statement
shall make me liable for appropriate action under Rule 16 of CCS(LTC)
Rules, 1988 and the relevant disciplinary rules.
* N.B.: Government employee may share interesting insights and pictures,
if any, of the destination visited while availing LTC on an appropriate
forum.
