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.
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