INDIAN INSTITUTE OF TECHNOLOGY : DELHI
 HAUZ KHAS NEW DELHI - 16

 APPLICATION FORM FOR GRANT OF TRAVEL CONCESSION
 ADVANCE OF MINISTRY OF HOME AFFAIRS MEMORANDUM
 NO.3.2.1957 (DATED : 1.4.1956)

1. Name & Designation of the    :
 Government servant
 (in Block Letters)

2. Pay including Dearness pay,    :
 if any.

3. Whether permanent of temporary.  :

4. Name & Designation of staff
 members from whom surety body   :
 is attached (in case of
 applicants who are temporary)

5. Nature and period of leave   :
 sanctioned.

6. S.No.Name Designation     :
 Particulars of the members of
 family (including self) for
 whom advance is applied for
 (giving the name, age and
 relationship, with the
 applicant.

7. Name of the Home Town already   :
 declare and accepted, with
 the nearest railway station
 (in block letters)

8. Declared place other than    :
 Home Town

9. Distance of Home town for   :
 declared place of journey
 from Head Quarters

10. Period of anticipated absence   :
 of the members of the family.
 
 
 
 
 
 
 
 
 

CERTIFICATE FROM THE STAFF MEMBERS

1. Certified that I am availing the concession for the first time during the Block Year.

2. The family members for whom travel concession advance has been claimed are wholly dependent upon and residing with me.  The income of parents/male children does not exceed Rs.250/- from all sources.

3. I promise to refund the advance for with if the outward journey is not commenced within 30 days of the grant of advance.

4. I promise to refund to government one half of the advance forthwith where the advance has been drawn for both the forward and return journey and later it because clear that the period of absence from head quarters is likely to exceed 90 days.

5. I promise to submit the travelling allowance claim in adjustment of the advance drawn within one month of the completion of the return journey.

6. I promise to report the date of completion of my journey within three days of its completion.

7. My spouse is/was got employed (certificate from the Deptt.) regarding non-availment of LTC is attached.

8. I will produce the Railway ticket/receipts/charted bus receipt within 10 days from the date of drawal for advance for verification, (in cases where the advance is drawn 60 days before the proposed date of outward journey).

9. In case of failure to the above concetions I authorise the Accounts Section to recover full amount of the advance from my salary in Lump sum.
 
 
 

 SIGNATURE OF THE GOVT. SERVANT
NAME :
 DESIGNATION :
 DEPTT/SECTION :

Forwarded to Estt.Section
for necessary action.

Remarks of the sanctioning
authority.
 Head of Deptt/Section/Unit.

The particulars as given above by Shri__________________________ have been verified and found correct.
 

 ASSISTANT REGISTRAR