KENDRIYA VIDYALAYA ______________ Application for grant of permission to avail LTC 1

Name of Applicant

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Designation

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Section to which attached

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Date of the appointment in the sangathan & the present cadre

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Place of visit with nearest Railway Station

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Details of family members in whose respect LTC is proposed to be claimed giving their age (date of birth in case of children)

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Whether family members for whom LTC is proposed to be claimed is/ are residing at the place of duty or away from the place of duty and if so, mention the place

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Block year for which LTC is claimed

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Train fare/ Bus fare per head for onward journey

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Total anticipated expenditure on train/bus fare to & fro fare of entitled class vix. Chair Sleeper/I/II/Class

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90% fare of the total anticipated fare & amount of advance required

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IN case husband/wife is employed in a Govt./Autonomous organization/ public undertaking whether he/she is availing LTC facility for self only or for other family members(s) also

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A.

I hereby declare that I am claiming the LTC in respect of family members who are actually dependent on me & are residing at my town.

Date 00.07.00 Recommendations of the controlling authority.

Signature of applicant