Ltc, Ta, Gpf,medical Forms For Central Govt Employees 2b6j34
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Application form for grant of LTC advance 1.
Name of the Government Servant
2.
Designation Date of entering the Central Government
3.
Service
4.
PAY + SI + NPA
5.
Whether permanent or temporary
6.
Home Town as recorded in the Service Book Whether wife / husband is employed and if
7.
so whether entitled to LTC Whether the concession is to be availed for
8.
visiting home town and if so block for which LTC is to be availed. (a) If the concession is to visit anywhere in
9.
India, the place to be visited. (b) Block for which to be availed. Single
10.
rail
fare/bus
fare
from
the
headquarters to home town/place of visit by shortest route. Persons in respect of whom LTC is proposed to be availed.
11.
S.No 1. 2. 3. 4.
Name
Age
Relationship
5. 6. 12.
Amount of advance required.
Rs.
I declare that the particulars furnished above are true and correct to the best of my knowledge. undertake to produce the tickets for the outward journey within ten days of receipt of the advance.
I
In the event of cancellation of the 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 lump sum. Date Signature of Government Servant.
G.A.R. 14-C Sub Bill No._________
LEAVE TRAVEL CONCESSION BILL FOR THE BLOCK OF YEAR_____________TO_____ Note:-- This bill should be prepared in duplicate—one for payment and the other as office copy.
PART – A (To be filled up by Government Servant) 1.
Name of the Government Servant
2.
Designation
3.
PAY + SI + NPA
4.
Headquarters
5.
Nature and period of leave sanctioned
6.
From To Particulars of of family in respect of whom the L.T.C. has been claimed. S. No. 1.
Name (s)
Age
Relationship with the Government Servant
2. 3. 4. 5. 6. 7.
Details of journey (s) performed by Government servant and the of his/her family. Mode of Travel Departure Arrival Distance & Fair class of No of Date & Date & in Kms fares paid accommodation From To Time Time used
8.
Amount of advance, if any, drawn Rs.
Remarks
9.
Particulars of journey (s) for which higher class of accommodation than the one to which the Government servant is entitled was used. (Sanction No. & Date to be given.) Place Fare paid Mode of Class to which Class by No of conveyance entitled. which Fares From To Rs. P. actually travelled
10.
Particulars of journey (s) performed by road between places connected by rail Nature of Place
From
To
Class to which entitled
Rail fare Rs.
P.
Certified that the:1. Information, as given above is true to the best of my knowledge and belief; and 2. That my husband/wife is not employed in Government service / that my husband/wife is employed in government service and the concession has not been availed of by him/her separately or himself/herself or for any of the family of the concerned block of _____________Years. Date_______________________ Signature of Government Servant Part – B ( to be filled in the Bill Section ) 1. The net entitlement on of leave travel concession works out to Rs._______________________ as detailed below:(a) Railway/Air/Bus/Steamer fare Rs._______________________________ (b) Less amount of advance drawan vide Voucher No______________dated__________ Rs._______________________________ ________________________________________ Net Amount Rs. ________________________________________
2.
The expenditure is debitable to
Initial of Bill Clerk
Signature of Drawing & Disbursing Officer
Counter signed
Certified that necessary entries Shri/Shrimati/Miss______________________
have
been
made
Signature of Controlling Officer in the Service Book of
Signature of the officer authorized to attest entries in the Service Book. ed for Rs.………………………….Rupees……………..……………………………………………………………… ……………………………………………………………………………………………………………………………………..
Signature of Controlling Officer
FOR USE IN S BRANCH / PAY AND S OFFICE VOUCHER NO……………………………DATED…………………… Pay Rs…………………………………..Rupees……………………………………………………………………………… Vide Cheque No……………………………………….dated………………………………………………………………..
Signature of the Drawing and Disbursing Officer
LTC CERTIFICATE CERTIFICATES TO BE GIVEN BY THE CONTROLLING OFFICER Certified : (i)
that Shri/Shrimati/Kumari (Name of the Govt. Servant)………………………………………………………………………… Has rendered continuous service for one year or more on the date of commencing the outward journey.
(ii)
that necessary entries as required under para 3 of the Ministry of Home Affairs O.M. No.43/1/55-Ests.(A) Part II dated 11th October, 1956 have made in the Service book of Shri/Shrimati/Kumari …………………………………………………………………………
Signature & Designation of the Controlling Officer
CERTIFICAT TO BE GIVEN BY THE GOVT. SERVANT
1.
I have not submitted any other claim so for Leave Travel Concession in respect of myself or my family in r/o the block of the years…………………………………and…………………………………
2.
I have already drawn TA for the Leave Travel Concession in respect of journey performed by me/my wife with……………………………..children. The claim is in respect to the journey performed by my wife/myself with ……………………………children none of whom traveled with the party on the earlier occasion.
3.
I have not already drawn TA for the Leave Travel Concession in respect of a journey performed by me/my wife with……………………………..children/………………………children in respect of the block of two years……………………………..and ………………………………..This claim is in respect of the journey performed by my wife with……………………………..children/………………………children none of whom availed of the concession relating to that block.
4.
I have already drawn TA for the Leave Travel Concession in r/o a journey performed by me in the year………………………………………in r/o of block of two years…………………………and…………………….. This claim is in r/o of the journey performed by me in the year……………………………………..This is against the concession issible once every year in a prescribed block for visiting home town as all the of my family are living away from place of work.
5.
The journey has been performed by me/my wife……………………..children/……………………………………..children to the declare home town viz………………………………………………
6.
That my husband/wife is not employed in Government. That my husband/wife is employed in Government Service and the concession has not been availed of by him/her separately for himself/herself or for any of the family for the concerned block of two years.
7.
Certified that my wife/husband for whom L.T.C. is claimed by me is employed in …………………………………………………………………………….(Name of the Public Sector Undertaking/Corporation/Autonomous body etc.) which provides Leave Travel Concession facilities but he/she has not preferred and will not prefer, any claim in this behalf from his/her employer. 8. Certified that my wife/husband for whom L.T.C. is claimed by me is not employed in any Public Sector Undertaking/Corporation/Autonomous body financed wholly or partly owned by the Central Government Local Body which provides L.T.C facilities to its employees and their families.
Signature of Government Servant
CONVEYANCE HIRE CLAIM 1.
Name of the Government Servant
2.
Designation
3.
Officer / Section to which attached
4.
Department Name
10.
Particulars of journey for which conveyance is claimed.
Date of Journey & time Date Time 1
2
Particulars From
To
3
4
Mode of conveyance
Distance in Kms
Purpose of Journey
Amount Spent in Rs.
5
6
7
8
Note:- In case of Taxi / Scooter hire the Registration No of the vehicle should be quoted and fare receipt be enclosed. Date____________
Signature of the Claimant___________________________________ Name and Designation of the Claimant_________________________
G.A.R. 14 -- A
Sub Bill No._________________ TRAVELLING ALLOWANCE BILL FOR TOUR Note: - This bill should be prepared in duplicate – one for payment and the other as office copy PART – A ( To be filled up by Government Servant )
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Certified that the information, as given above, is true to the best of my knowledge and belief. ( ) Signature of the Government Servant Date____________________________
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Certified that I/my family was neither allowed free transit by Rail under free or otherwise provided with means of communication at expense of the state or Local Bodies journey for which T.A. has been claimed in this bill.
2.
Certified that I/my family actually traveled by the class for which T.A. has been claimed in this bill.
3.
Certified that the number of kilometers shown in the bill is in accordance with the poly maternal tables of the establishment.
4.
Certified that the journey on …………………….was performed by Mail/Express train in the interest public service.
5.
Certified that I was actually not merely constructively in camp on Sundays and holidays for which daily allowance is claimed.
6.
Certified that I was not absent on Casual Leave during the period for which daily allowance has been claimed.
7.
Certified during my halt at………………………………………………………………….from ….……………………………… to ………………………………………………while on inspection duty continue to incur expenditure after the first 10 days.
8.
Certified that I did not perform the road journey for which the kilometer allowance has been claimed at the higher rates rule 46 of Supplementary rule by taking a single seat in a taxi/motor or mini bus or lorry playing for hire.
9.
Certified that I incurred running expenses in a car for which claimed in this bill for journey.
10.
Certified that the road journeys for which kilometer has been claimed at the higher prescribed in Supplementary rule 46 was performed by my own car.
11.
Certified that the road journeys for which mileage is claimed were performed by road but were charged by rail. The number of kilometers actually traveled by road being…………………….…………
12.
Certified that the family for whom T.A. has been claimed actually travelled with me or followed me on transfer. They were wholly dependent upon me & residing with me.
13.
Certified that actual expenses incurred as cost or transportation of personal effects were not less than the sum claimed in the bill.
14.
Certified that I have transported………………………………………………………………………kgms. of luggage on my transfer from………………………………………….to………………………………………..
' 5 $
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G.A.R. 14 -- B [ See Rule 66 (1) & 90 (1), (I) ] Sub Bill No._________________ TRAVELLING ALLOWANCE BILL FOR TRANSFER Note: - This bill should be prepared in duplicate – one for payment and the other as office copy PART – A ( To be filled up by Government Servant )
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Certified that I/my family was neither allowed free transit by Rail under free or otherwise provided with means of communication at expense of the state or Local Bodies journey for which T.A. has been claimed in this bill.
2.
Certified that I/my family actually traveled by the class for which T.A. has been claimed in this bill.
3.
Certified that the number of kilometers shown in the bill is in accordance with the poly maternal tables of the establishment.
4.
Certified that the journey on …………………….was performed by Mail/Express train in the interest public service.
5.
Certified that I was actually not merely constructively in camp on Sundays and holidays for which daily allowance is claimed.
6.
Certified that I was not absent on Casual Leave during the period for which daily allowance has been claimed.
7.
Certified during my halt at………………………………………………………………….from ….……………………………… to ………………………………………………while on inspection duty continue to incur expenditure after the first 10 days.
8.
Certified that I did not perform the road journey for which the kilometer allowance has been claimed at the higher rates rule 46 of Supplementary rule by taking a single seat in a taxi/motor or mini bus or lorry playing for hire.
9.
Certified that I incurred running expenses in a car for which claimed in this bill for journey.
10.
Certified that the road journeys for which kilometer has been claimed at the higher prescribed in Supplementary rule 46 was performed by my own car.
11.
Certified that the road journeys for which mileage is claimed were performed by road but were charged by rail. The number of kilometers actually traveled by road being…………………….…………
12.
Certified that the family for whom T.A. has been claimed actually travelled with me or followed me on transfer. They were wholly dependent upon me & residing with me.
13.
Certified that actual expenses incurred as cost or transportation of personal effects were not less than the sum claimed in the bill.
14.
Certified that I have transported………………………………………………………………………kgms. of luggage on my transfer from………………………………………….to………………………………………..
' 5 $
5
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Performa for application for advance from Provident Funds Application for Advance from G.P.F. 1.
Name of the Subscriber
2.
Number
3.
Designation
4.
Pay
5.
Balance at Credit of the subscriber on the date of application as below:-
Rs.
i Closing balance as per statement for the Rs year___________ ii Credit from _________to___________on Rs of monthly subscription. iii Refunds
Rs
iv Withdrawals during the period from Rs __________to_____________
6.
v Net balance at credit Amount of advance/outstanding, if any, and the
7. 8.
Amount of Advance required a. Purpose for which the advance is required
Rs
b
Rules under which the request is covered
c
If advance is sought for House Building etc., following information may be given:i
Location & measurement of the plot
ii
Whether plot is freehold or on lease
iii
Plan for construction
iv
If the flat or plot being purchased is from a H.B. Society, the name of Society, the location & measurement, etc. Cost of construction
v vi
d
If the purchase of flat is from DDA or any Housing Board etc., the location, dimension, etc., may be given. If advance is required for education of children, following details may be given:-
e
i
Name of the son / daughter
ii
Class & Institution / College where studying
iii
Whether a day-scholar or a hostler
If advance is required for treatment of ailing family , following details may be given:i Name of the patient and relationship ii
Name of the Hospital / Dispensary /Doctor where the patient is undergoing treatment.
iii
Whether outdoor / indoor patient
iv
9
10 .
Whether reimbursement available or not Amount of the consolidated advance (Items 6 Rs.__________________in ________ and 7 ) and number of monthly installments in Installments. which the consolidated advance is proposed to be repaid. Full Particulars of pecuniary circumstances of the subscriber, justifying the application for the advance
I certify that particulars given below are correct and complete to the best of my knowledge and belief and that nothing has been concealed by me. Date:-
Signature of the Applicant Name___________________________ Designation______________________ Section / Branch__________________
Note:- In case of advance under 8 © to 8 (e), no certificate or documentary evidence would be required.
Performa for application for withdrawal from Provident Funds Application for Advance from G.P.F. 1.
Name of the Subscriber
2.
Number
3.
Designation
4.
Pay
5.
Date of ing service and date of Superannuation
5.
Balance at Credit of the subscriber on the date of application as below:-
Rs.
i
Closing balance as per statement for the year___________
Rs
ii
Credit from _________to___________on of monthly subscription.
Rs
iii
Refunds made to the Fund after the closing balance , vide (i) above
Rs
iv
Withdrawals during the period __________to_____________
Rs
v
Net balance at credit on date of application
from
6.
Amount of Advance required
8.
a.
Purpose for which the withdrawal is required
b
Rules under which the request is covered
9
Whether any withdrawal was taken for the same purpose earlier. If so, indicate the amount and the year.
10 .
Name of the PAO maintaining the Provident Fund
Date:-
Rs
.
Signature of the Applicant Name___________________________ Designation______________________ Section / Branch__________________
Annexure-D Forms 1 Form of Application for Final Payment/Transfer to Corporate Bodies/Other Governments of Balances in the General Provident Fund To The Pay and s Officer, _________________________, _________________________, (Through the Head of Office) Sir, I am to retire/have retired have proceeded on leave preparatory to retirement for _________________________months/have been discharged/dismissed/have been permanently transferred to ________________________ / have resigned finally from Government service/have resigned service under ___________________ Government to take up appointment with ___________ and my resignation has been accepted with effect from _________________forenoon/afternoon. I ed service with______________ on______________forenoon/afternoon. 2.
My Provident Fund No. is __________________________
3. I desire to receive payment through my office through the ____________________Treasury/Sub Treasury. Particulars of my personal marks of identification left hand thumb and finger impressions ( in the case of illiterate subscribers and specimen signature ( in case of literate subscribers) in duplicate, duly attested by a Gazetted Officer of the Government, are enclosed. PART-I [To be filled in when the application for final payment is submitted up to one year prior to retirement] 4. I request that the amount of Rs.________________ standing to the credit in my Provident Fund as indicated in the s Statement issued to me for the yar ___________________(enclosed) / as appearing in my ledger being maintained by you_____________________________ Treasury/Sub Treasury/Head of Office, my please be arranged to be paid to me as first installment of final payment. 5.
******
6. After payment of the first installment of my Provident Fund balance, I will apply for the payment of subsequent installments in Part-II of the form immediately on retirement. Yours faithfully
Signature------------------------------Station-------------
Name________________________
Date:-___________
Address_____________________
This applies only when payment is not desired through the Head of Office. ( FOR USE BY HEADS OF OFFICES ) Forwarded to the Pay & s Officer_________________________ for necessary action. 2. The Provident Fund No.__________________ of Shri/Shrimati/Kumari (as certified from the Statements furnished to him/ her from year to year ) is ____________________________. 3. He/She is due to retire from Government on________________________________________________________.
Service
4. Certified that he/she had taken the following advances in respect of which______________________instalment of Rs._____________________are yet to be recovered and credited to the Fund . The details of the final withdrawals granted to him/her are also indicated below:Temporary Advances 1._________________________ 2. _________________________ 3. _________________________ 4. _________________________ 5.
Final Withdrawals ___________________________ ___________________________ ___________________________ ___________________________
****** Signature of the Head of Office
PART-II [To be submitted by the Subscriber immediately after his/her retirement. This Part is also applicable in the case of subscribers who apply for final payment for the first time after the date of superannuation, discharge, resignation etc. ] In continuation of my earlier application, dated___________________________, for the final payment of Provident Fund balances, I request that the entire balance at my credit with interest due under the rules may be paid to me. Or I request that the entire amount at my credit with interest due under the rules may be paid to me /transferred to ____________________________________. Signature------------------------------Name________________________ Address_______________________ ( FOR USE BY HEADS OF OFFICES ) Forwarded to the Pay & s Officer_________________________ for necessary action/in continuation of Endorsement No. _____________ dated__________. 2. He/She has finally retired/ will proceed on leave preparatory to retirement for _________________________months/have been discharged/dismissed/have been permanently transferred to ________________________ / have resigned finally from Government service/have resigned service under ___________________ Government to take up appointment with ___________ and my resignation has been accepted with effect from _________________forenoon/afternoon. He/She ed service with______________ on______________forenoon/afternoon. 3. The last fund deduction was made from his/her pay in this office bill No._______________, dated______________, for Rs.______________ (Rupees___________________________), cash voucher No._______________ of __________________Treasury, the amount of deduction being Rs._________________ and recovery on of refund of advance Rs.___________________. 4. Certified that he/she was neither sanctioned any tempory advance nor any final withdrawal from his/her Provident Fund during the 12 months immediately preceding the date of his /her quitting service under _______________________Government/proceeding on leave preparatory to retirement or thereafter or
Certified that the following temporary advances/final withdrawals were sanctioned to him/her and drawn from his/her Provident Fund during the 12 months immediately preceding the date of his/her quitting service under_________________________ Government/proceeding on leave preparatory to retirement or thereafter Amount of Advance/withdrawal 1._________________________ 2. _________________________ 3. _________________________ 4. _________________________
Date
Voucher number
___________________________ ___________________________ ___________________________ ___________________________
5. * * * * * * 6. It is certified that no demands/following demands of Government are due for recovery1. 7. Certified that he/she has not resigned from Government service with prior permission of the Central Government to take up an appointment in an other Department of the Central Government or under a State Government or under a body corporate owned or controlled by the State2.
Signature Of the Head of Office/Department
1. Certificate No.6 to be furnished in the case of Contributory Provident Fund Only. 2. Please score out if not necessary.
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Name of the Government Servant
2.
Designation Date of entering the Central Government
3.
Service
4.
PAY + SI + NPA
5.
Whether permanent or temporary
6.
Home Town as recorded in the Service Book Whether wife / husband is employed and if
7.
so whether entitled to LTC Whether the concession is to be availed for
8.
visiting home town and if so block for which LTC is to be availed. (a) If the concession is to visit anywhere in
9.
India, the place to be visited. (b) Block for which to be availed. Single
10.
rail
fare/bus
fare
from
the
headquarters to home town/place of visit by shortest route. Persons in respect of whom LTC is proposed to be availed.
11.
S.No 1. 2. 3. 4.
Name
Age
Relationship
5. 6. 12.
Amount of advance required.
Rs.
I declare that the particulars furnished above are true and correct to the best of my knowledge. undertake to produce the tickets for the outward journey within ten days of receipt of the advance.
I
In the event of cancellation of the 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 lump sum. Date Signature of Government Servant.
G.A.R. 14-C Sub Bill No._________
LEAVE TRAVEL CONCESSION BILL FOR THE BLOCK OF YEAR_____________TO_____ Note:-- This bill should be prepared in duplicate—one for payment and the other as office copy.
PART – A (To be filled up by Government Servant) 1.
Name of the Government Servant
2.
Designation
3.
PAY + SI + NPA
4.
Headquarters
5.
Nature and period of leave sanctioned
6.
From To Particulars of of family in respect of whom the L.T.C. has been claimed. S. No. 1.
Name (s)
Age
Relationship with the Government Servant
2. 3. 4. 5. 6. 7.
Details of journey (s) performed by Government servant and the of his/her family. Mode of Travel Departure Arrival Distance & Fair class of No of Date & Date & in Kms fares paid accommodation From To Time Time used
8.
Amount of advance, if any, drawn Rs.
Remarks
9.
Particulars of journey (s) for which higher class of accommodation than the one to which the Government servant is entitled was used. (Sanction No. & Date to be given.) Place Fare paid Mode of Class to which Class by No of conveyance entitled. which Fares From To Rs. P. actually travelled
10.
Particulars of journey (s) performed by road between places connected by rail Nature of Place
From
To
Class to which entitled
Rail fare Rs.
P.
Certified that the:1. Information, as given above is true to the best of my knowledge and belief; and 2. That my husband/wife is not employed in Government service / that my husband/wife is employed in government service and the concession has not been availed of by him/her separately or himself/herself or for any of the family of the concerned block of _____________Years. Date_______________________ Signature of Government Servant Part – B ( to be filled in the Bill Section ) 1. The net entitlement on of leave travel concession works out to Rs._______________________ as detailed below:(a) Railway/Air/Bus/Steamer fare Rs._______________________________ (b) Less amount of advance drawan vide Voucher No______________dated__________ Rs._______________________________ ________________________________________ Net Amount Rs. ________________________________________
2.
The expenditure is debitable to
Initial of Bill Clerk
Signature of Drawing & Disbursing Officer
Counter signed
Certified that necessary entries Shri/Shrimati/Miss______________________
have
been
made
Signature of Controlling Officer in the Service Book of
Signature of the officer authorized to attest entries in the Service Book. ed for Rs.………………………….Rupees……………..……………………………………………………………… ……………………………………………………………………………………………………………………………………..
Signature of Controlling Officer
FOR USE IN S BRANCH / PAY AND S OFFICE VOUCHER NO……………………………DATED…………………… Pay Rs…………………………………..Rupees……………………………………………………………………………… Vide Cheque No……………………………………….dated………………………………………………………………..
Signature of the Drawing and Disbursing Officer
LTC CERTIFICATE CERTIFICATES TO BE GIVEN BY THE CONTROLLING OFFICER Certified : (i)
that Shri/Shrimati/Kumari (Name of the Govt. Servant)………………………………………………………………………… Has rendered continuous service for one year or more on the date of commencing the outward journey.
(ii)
that necessary entries as required under para 3 of the Ministry of Home Affairs O.M. No.43/1/55-Ests.(A) Part II dated 11th October, 1956 have made in the Service book of Shri/Shrimati/Kumari …………………………………………………………………………
Signature & Designation of the Controlling Officer
CERTIFICAT TO BE GIVEN BY THE GOVT. SERVANT
1.
I have not submitted any other claim so for Leave Travel Concession in respect of myself or my family in r/o the block of the years…………………………………and…………………………………
2.
I have already drawn TA for the Leave Travel Concession in respect of journey performed by me/my wife with……………………………..children. The claim is in respect to the journey performed by my wife/myself with ……………………………children none of whom traveled with the party on the earlier occasion.
3.
I have not already drawn TA for the Leave Travel Concession in respect of a journey performed by me/my wife with……………………………..children/………………………children in respect of the block of two years……………………………..and ………………………………..This claim is in respect of the journey performed by my wife with……………………………..children/………………………children none of whom availed of the concession relating to that block.
4.
I have already drawn TA for the Leave Travel Concession in r/o a journey performed by me in the year………………………………………in r/o of block of two years…………………………and…………………….. This claim is in r/o of the journey performed by me in the year……………………………………..This is against the concession issible once every year in a prescribed block for visiting home town as all the of my family are living away from place of work.
5.
The journey has been performed by me/my wife……………………..children/……………………………………..children to the declare home town viz………………………………………………
6.
That my husband/wife is not employed in Government. That my husband/wife is employed in Government Service and the concession has not been availed of by him/her separately for himself/herself or for any of the family for the concerned block of two years.
7.
Certified that my wife/husband for whom L.T.C. is claimed by me is employed in …………………………………………………………………………….(Name of the Public Sector Undertaking/Corporation/Autonomous body etc.) which provides Leave Travel Concession facilities but he/she has not preferred and will not prefer, any claim in this behalf from his/her employer. 8. Certified that my wife/husband for whom L.T.C. is claimed by me is not employed in any Public Sector Undertaking/Corporation/Autonomous body financed wholly or partly owned by the Central Government Local Body which provides L.T.C facilities to its employees and their families.
Signature of Government Servant
CONVEYANCE HIRE CLAIM 1.
Name of the Government Servant
2.
Designation
3.
Officer / Section to which attached
4.
Department Name
10.
Particulars of journey for which conveyance is claimed.
Date of Journey & time Date Time 1
2
Particulars From
To
3
4
Mode of conveyance
Distance in Kms
Purpose of Journey
Amount Spent in Rs.
5
6
7
8
Note:- In case of Taxi / Scooter hire the Registration No of the vehicle should be quoted and fare receipt be enclosed. Date____________
Signature of the Claimant___________________________________ Name and Designation of the Claimant_________________________
G.A.R. 14 -- A
Sub Bill No._________________ TRAVELLING ALLOWANCE BILL FOR TOUR Note: - This bill should be prepared in duplicate – one for payment and the other as office copy PART – A ( To be filled up by Government Servant )
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2.
Certified that I/my family actually traveled by the class for which T.A. has been claimed in this bill.
3.
Certified that the number of kilometers shown in the bill is in accordance with the poly maternal tables of the establishment.
4.
Certified that the journey on …………………….was performed by Mail/Express train in the interest public service.
5.
Certified that I was actually not merely constructively in camp on Sundays and holidays for which daily allowance is claimed.
6.
Certified that I was not absent on Casual Leave during the period for which daily allowance has been claimed.
7.
Certified during my halt at………………………………………………………………….from ….……………………………… to ………………………………………………while on inspection duty continue to incur expenditure after the first 10 days.
8.
Certified that I did not perform the road journey for which the kilometer allowance has been claimed at the higher rates rule 46 of Supplementary rule by taking a single seat in a taxi/motor or mini bus or lorry playing for hire.
9.
Certified that I incurred running expenses in a car for which claimed in this bill for journey.
10.
Certified that the road journeys for which kilometer has been claimed at the higher prescribed in Supplementary rule 46 was performed by my own car.
11.
Certified that the road journeys for which mileage is claimed were performed by road but were charged by rail. The number of kilometers actually traveled by road being…………………….…………
12.
Certified that the family for whom T.A. has been claimed actually travelled with me or followed me on transfer. They were wholly dependent upon me & residing with me.
13.
Certified that actual expenses incurred as cost or transportation of personal effects were not less than the sum claimed in the bill.
14.
Certified that I have transported………………………………………………………………………kgms. of luggage on my transfer from………………………………………….to………………………………………..
' 5 $
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G.A.R. 14 -- B [ See Rule 66 (1) & 90 (1), (I) ] Sub Bill No._________________ TRAVELLING ALLOWANCE BILL FOR TRANSFER Note: - This bill should be prepared in duplicate – one for payment and the other as office copy PART – A ( To be filled up by Government Servant )
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2.
Certified that I/my family actually traveled by the class for which T.A. has been claimed in this bill.
3.
Certified that the number of kilometers shown in the bill is in accordance with the poly maternal tables of the establishment.
4.
Certified that the journey on …………………….was performed by Mail/Express train in the interest public service.
5.
Certified that I was actually not merely constructively in camp on Sundays and holidays for which daily allowance is claimed.
6.
Certified that I was not absent on Casual Leave during the period for which daily allowance has been claimed.
7.
Certified during my halt at………………………………………………………………….from ….……………………………… to ………………………………………………while on inspection duty continue to incur expenditure after the first 10 days.
8.
Certified that I did not perform the road journey for which the kilometer allowance has been claimed at the higher rates rule 46 of Supplementary rule by taking a single seat in a taxi/motor or mini bus or lorry playing for hire.
9.
Certified that I incurred running expenses in a car for which claimed in this bill for journey.
10.
Certified that the road journeys for which kilometer has been claimed at the higher prescribed in Supplementary rule 46 was performed by my own car.
11.
Certified that the road journeys for which mileage is claimed were performed by road but were charged by rail. The number of kilometers actually traveled by road being…………………….…………
12.
Certified that the family for whom T.A. has been claimed actually travelled with me or followed me on transfer. They were wholly dependent upon me & residing with me.
13.
Certified that actual expenses incurred as cost or transportation of personal effects were not less than the sum claimed in the bill.
14.
Certified that I have transported………………………………………………………………………kgms. of luggage on my transfer from………………………………………….to………………………………………..
' 5 $
5
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Performa for application for advance from Provident Funds Application for Advance from G.P.F. 1.
Name of the Subscriber
2.
Number
3.
Designation
4.
Pay
5.
Balance at Credit of the subscriber on the date of application as below:-
Rs.
i Closing balance as per statement for the Rs year___________ ii Credit from _________to___________on Rs of monthly subscription. iii Refunds
Rs
iv Withdrawals during the period from Rs __________to_____________
6.
v Net balance at credit Amount of advance/outstanding, if any, and the
7. 8.
Amount of Advance required a. Purpose for which the advance is required
Rs
b
Rules under which the request is covered
c
If advance is sought for House Building etc., following information may be given:i
Location & measurement of the plot
ii
Whether plot is freehold or on lease
iii
Plan for construction
iv
If the flat or plot being purchased is from a H.B. Society, the name of Society, the location & measurement, etc. Cost of construction
v vi
d
If the purchase of flat is from DDA or any Housing Board etc., the location, dimension, etc., may be given. If advance is required for education of children, following details may be given:-
e
i
Name of the son / daughter
ii
Class & Institution / College where studying
iii
Whether a day-scholar or a hostler
If advance is required for treatment of ailing family , following details may be given:i Name of the patient and relationship ii
Name of the Hospital / Dispensary /Doctor where the patient is undergoing treatment.
iii
Whether outdoor / indoor patient
iv
9
10 .
Whether reimbursement available or not Amount of the consolidated advance (Items 6 Rs.__________________in ________ and 7 ) and number of monthly installments in Installments. which the consolidated advance is proposed to be repaid. Full Particulars of pecuniary circumstances of the subscriber, justifying the application for the advance
I certify that particulars given below are correct and complete to the best of my knowledge and belief and that nothing has been concealed by me. Date:-
Signature of the Applicant Name___________________________ Designation______________________ Section / Branch__________________
Note:- In case of advance under 8 © to 8 (e), no certificate or documentary evidence would be required.
Performa for application for withdrawal from Provident Funds Application for Advance from G.P.F. 1.
Name of the Subscriber
2.
Number
3.
Designation
4.
Pay
5.
Date of ing service and date of Superannuation
5.
Balance at Credit of the subscriber on the date of application as below:-
Rs.
i
Closing balance as per statement for the year___________
Rs
ii
Credit from _________to___________on of monthly subscription.
Rs
iii
Refunds made to the Fund after the closing balance , vide (i) above
Rs
iv
Withdrawals during the period __________to_____________
Rs
v
Net balance at credit on date of application
from
6.
Amount of Advance required
8.
a.
Purpose for which the withdrawal is required
b
Rules under which the request is covered
9
Whether any withdrawal was taken for the same purpose earlier. If so, indicate the amount and the year.
10 .
Name of the PAO maintaining the Provident Fund
Date:-
Rs
.
Signature of the Applicant Name___________________________ Designation______________________ Section / Branch__________________
Annexure-D Forms 1 Form of Application for Final Payment/Transfer to Corporate Bodies/Other Governments of Balances in the General Provident Fund To The Pay and s Officer, _________________________, _________________________, (Through the Head of Office) Sir, I am to retire/have retired have proceeded on leave preparatory to retirement for _________________________months/have been discharged/dismissed/have been permanently transferred to ________________________ / have resigned finally from Government service/have resigned service under ___________________ Government to take up appointment with ___________ and my resignation has been accepted with effect from _________________forenoon/afternoon. I ed service with______________ on______________forenoon/afternoon. 2.
My Provident Fund No. is __________________________
3. I desire to receive payment through my office through the ____________________Treasury/Sub Treasury. Particulars of my personal marks of identification left hand thumb and finger impressions ( in the case of illiterate subscribers and specimen signature ( in case of literate subscribers) in duplicate, duly attested by a Gazetted Officer of the Government, are enclosed. PART-I [To be filled in when the application for final payment is submitted up to one year prior to retirement] 4. I request that the amount of Rs.________________ standing to the credit in my Provident Fund as indicated in the s Statement issued to me for the yar ___________________(enclosed) / as appearing in my ledger being maintained by you_____________________________ Treasury/Sub Treasury/Head of Office, my please be arranged to be paid to me as first installment of final payment. 5.
******
6. After payment of the first installment of my Provident Fund balance, I will apply for the payment of subsequent installments in Part-II of the form immediately on retirement. Yours faithfully
Signature------------------------------Station-------------
Name________________________
Date:-___________
Address_____________________
This applies only when payment is not desired through the Head of Office. ( FOR USE BY HEADS OF OFFICES ) Forwarded to the Pay & s Officer_________________________ for necessary action. 2. The Provident Fund No.__________________ of Shri/Shrimati/Kumari (as certified from the Statements furnished to him/ her from year to year ) is ____________________________. 3. He/She is due to retire from Government on________________________________________________________.
Service
4. Certified that he/she had taken the following advances in respect of which______________________instalment of Rs._____________________are yet to be recovered and credited to the Fund . The details of the final withdrawals granted to him/her are also indicated below:Temporary Advances 1._________________________ 2. _________________________ 3. _________________________ 4. _________________________ 5.
Final Withdrawals ___________________________ ___________________________ ___________________________ ___________________________
****** Signature of the Head of Office
PART-II [To be submitted by the Subscriber immediately after his/her retirement. This Part is also applicable in the case of subscribers who apply for final payment for the first time after the date of superannuation, discharge, resignation etc. ] In continuation of my earlier application, dated___________________________, for the final payment of Provident Fund balances, I request that the entire balance at my credit with interest due under the rules may be paid to me. Or I request that the entire amount at my credit with interest due under the rules may be paid to me /transferred to ____________________________________. Signature------------------------------Name________________________ Address_______________________ ( FOR USE BY HEADS OF OFFICES ) Forwarded to the Pay & s Officer_________________________ for necessary action/in continuation of Endorsement No. _____________ dated__________. 2. He/She has finally retired/ will proceed on leave preparatory to retirement for _________________________months/have been discharged/dismissed/have been permanently transferred to ________________________ / have resigned finally from Government service/have resigned service under ___________________ Government to take up appointment with ___________ and my resignation has been accepted with effect from _________________forenoon/afternoon. He/She ed service with______________ on______________forenoon/afternoon. 3. The last fund deduction was made from his/her pay in this office bill No._______________, dated______________, for Rs.______________ (Rupees___________________________), cash voucher No._______________ of __________________Treasury, the amount of deduction being Rs._________________ and recovery on of refund of advance Rs.___________________. 4. Certified that he/she was neither sanctioned any tempory advance nor any final withdrawal from his/her Provident Fund during the 12 months immediately preceding the date of his /her quitting service under _______________________Government/proceeding on leave preparatory to retirement or thereafter or
Certified that the following temporary advances/final withdrawals were sanctioned to him/her and drawn from his/her Provident Fund during the 12 months immediately preceding the date of his/her quitting service under_________________________ Government/proceeding on leave preparatory to retirement or thereafter Amount of Advance/withdrawal 1._________________________ 2. _________________________ 3. _________________________ 4. _________________________
Date
Voucher number
___________________________ ___________________________ ___________________________ ___________________________
5. * * * * * * 6. It is certified that no demands/following demands of Government are due for recovery1. 7. Certified that he/she has not resigned from Government service with prior permission of the Central Government to take up an appointment in an other Department of the Central Government or under a State Government or under a body corporate owned or controlled by the State2.
Signature Of the Head of Office/Department
1. Certificate No.6 to be furnished in the case of Contributory Provident Fund Only. 2. Please score out if not necessary.
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