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Leave Travel Assistance Claim Form

This Leave Travel Assistance Claim Form contains the employee's personal details, travel details for self and family members, a certification of travel expenses from the employee, and sections for the HR and Accounts departments to process the claim. The employee provides names, ages and relations of traveling family members as well as travel dates and locations. They certify spending amounts towards travel fare and request tax exemption as applicable. HR then confirms past LTA payments and approves entitlement amounts, paying the net amount due. Accounts then processes the exemptions, taxes and net payable.

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shivamanoj
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647 views1 page

Leave Travel Assistance Claim Form

This Leave Travel Assistance Claim Form contains the employee's personal details, travel details for self and family members, a certification of travel expenses from the employee, and sections for the HR and Accounts departments to process the claim. The employee provides names, ages and relations of traveling family members as well as travel dates and locations. They certify spending amounts towards travel fare and request tax exemption as applicable. HR then confirms past LTA payments and approves entitlement amounts, paying the net amount due. Accounts then processes the exemptions, taxes and net payable.

Uploaded by

shivamanoj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Leave Travel Assistance Claim Form

Employee Name Name of Company


Emp. Code Designation Dept.
Duration of leave From To
Place of Travel From To
Date of Travel From To

Name (s) and Age of Family Members


Sr. Name Age Date of Relation Mode of Class of PNR Amount
No. birth (only Transport Travel/Car No./Air Rs._
for (Air/Train/ Model No. Ticket Mention
children) Car/Bus No.(**)/Car only
Invoice No. Traveling
(*) Fare
1 Self
2
3
4
5
6

I hereby certify that I have spent an amount of Rs. _________ (Rupees ____________________) towards Travel Fare expenses
for self, spouse and my dependents for traveling to ______________as per attached relevant supportings and details of
the travel. I am aware that the block of LTA is from 2018 to 2021 . Kindly allow exemption as applicable under the Income
Tax Act and pay me LTA as per my entitlements. .

Date Employee Signature

For HR Department Only - To confirm the number of payments taken by employee in a block as below.

Details of LTA Payment Details of LTA Payment


Year Date Signature Year Date Signature
2014 2018
2015 2019
2016 2020
2017 2021

LTA entitlement of Mr. / Ms. / Dr. _____________________________for the year _________to ________ is Rs.
______________Adjusted Rs.________________ against existing loan. Please pay Rs.__________ and account for Income Tax
as applicable.
HR Voucher No. Date Signature :

For Accounts Department only

Entitlement Exempted
Taxable Income Tax to be covered
Total Net payable
Signature

Note :
* The exemption will not be available for more than 2 children born after 01/10/1998
**Air fare is only applicable for Shortest Route for Domestic Travel as per National Airlines (i. e. Air India) and for
Economy Class only.

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