Railway: Application form for grant of AILTC advance - To be submitted to concerned ERB Section | Annexure-II

Annexure-II

Application form for grant of AILTC advance

(To be submitted to concerned ERB Section)

I. Name of the Railway servant:................................................................................................................

2. Designation: .........................................................................................................................................

3. Employee Number: ..............................................................................................................................

4. Date of Joining in Railway Service/Railway Board: ...........................................................................

5. Present pay & Pay Level: .....................................................................................................................

6. Whether permanent or temporary: .......................................................................................................

7. Whether original copy of PPSC submitted along with Intimation: ......................................................

8. Whether spouse is employed and if so whether entitled to LTC: .........................................................

9. a) The concession is to "visit anywhere in India'', the place to be visited: ..........................................

b) Block for which to be availed: .............................................................................................................

10. Single Rail fare/Bus fare/Air fare from the headquai1ers to place of visit by shortest route (both to and fro): ....................................................................................................................................................

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11 . Persons in respect of whom AILTC is proposed to be availed: ........................................................

S. No.	Name(s)	Age	Relationship with the Government Servent
I
II
III
IV

12. Amount of advance required Rs..........................................................................................................

I declare that the particulars furnished above are true and correct to the best of my knowledge. I undertake to produce the tickets for the outward journey within ten days of receipt of the advance. In the event of cancellation of journey or if I fail to produce the tickets within ten days of receipt of advance, I undertake to refund the entire advance in one lumpsum.

Date: ...................

Signature:....................................

RUID NO....................................

Mobile No. .................................

(For use in Office)

I . Particulars in Cols. I to 7 verified: (To be verified by concerned ERB Branch)

2. Amount entitled for reimbursement: --------------------

3. Advance admissible (90% of amount): -----------------

Advance of Rs. ........................... may be sanctioned.

US/SO of concerned ERB Section for S.No.1

US/SO of concerned Cash Section for S.No.2 & 3:

PAO