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LTA Form

This document is a leave travel allowance claim form submitted by an employee. It includes details of family members who traveled, dates of travel, mode of transportation, costs, and declarations signed by the employee. The form requires sign off from HR and accounting departments.

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shuryagoengi
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25 views2 pages

LTA Form

This document is a leave travel allowance claim form submitted by an employee. It includes details of family members who traveled, dates of travel, mode of transportation, costs, and declarations signed by the employee. The form requires sign off from HR and accounting departments.

Uploaded by

shuryagoengi
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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HexBPS 3204

Claim for Leave Travel Allowance

The Human Resource Department

Dear Sir/Madam,
Through: Departmental Head

This is to inform you that I have incurred the following expenditure on account of leave travel availed by me for
the calendar year ________ to _________. The necessary proof of travel is enclosed herewith for your records.

Kindly arrange to pay the same:


Sr. No. Names M/F Age Relationship Traveled Mode One-way Total
From To
1
2
3
4
5
6

Total :_________________ Rs. ___________________________________________________


________________________________________________ (in words)

I hereby declare that:


1. My wife, parents, children, brothers, sisters who traveled with me are entirely dependent on me.
2. The above information is true and I will completely be responsible for the income tax liability that may arise
on account my LTA claim which is being submitted.
3. I hereby declare that I have availed PL from _______________ to ___________________.

Thanking you
Yours faithfully,

----------------- ------------------------ ------------------------- ------------------------


Emp. No. Name Signature Date

HR Department Payroll/Accounts Department


Leave Availed: Amount to be passed :

Date of Joining: Amount to be exempted:

Amount to be taxed

Sanctioned by Sanctioned by

( Name & Sign ) ( Name & Sign )

Note: Please note that no LTA claim will be passed until it is enclosed with necessary supporting documents in
ORIGINAL.(only tickets are allowed)

LTA can be claimed on the completion of every year of service in the company

Exemption is limited to the Fare Expenses actually incurred for self and Family members of an employee, for travel to any
place in India. Family includes spouse and children and parents, brothers and sisters if dependent on the employee.

_________________________________________________________________________________________________
Finance For Internal Use Only Version 1.1
Page 1
HexBPS 3204
Claim for Leave Travel Allowance
Amount of Fare exempt is limited up to First Class AC Rail Fare or Economy Class Air Fare or Public Transport Deluxe Bus
Fare.

Exemption is available for only 2 journeys in a block of 4 calendar years. Such Block, which is currently applicable, has
commenced on 1.1.2022 and will end on 31.12.2025.

_________________________________________________________________________________________________
Finance For Internal Use Only Version 1.1
Page 2

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