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Railway: Proforma for self-certification/Declaration by the Railway Employees intending to avail AILTC - Annexure-I

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Railway: Proforma for self-certification/Declaration by the Railway Employees intending to avail AILTC  - Annexure-I

Annexure-I

Proforma for self-certification/Declaration by the Railway Employees intending to avail AILTC 

I Shri./Smt./Km. .................................................................... (Name of the Railway servant) wish to confirm that I am availing AILTC (Any place in India) 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 fam ily mem ber for whom I wish to avail AILTC has/have not availed of the same during the present block year. 


2. Particulars of men bers of family, who are dependent on me, in respect of whom the all India Leave Travel Concession is being claimed are as under:
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S. No.Name(s)AgeRelationship with the Government Servent
I
II
III
IV

3. I am enclosing original copy of PPSC issued on................................................... to me by PIA. 

3.1 A copy of my leave application is also enclosed. 

4. 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 as applicable to Railway servant. 

Signature of Railway Servant: ............................

Name:...................................................................

Designation/Branch: ...........................................

RUID No & Employee No:.................................

Mobile No. : .......................................................

................................................................................
Signature with date of SO/Branch Officer/lncharge 
ERB-I/II/V

*N.B: Railway employee may share interesting insights and pictures, if any, of the destination visited while availing AILTC on an appropriate forum.

self-certification-declaration-form-avail-ailtc-railway-employees-annexure-I


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