Congingent Bill Form for Reimbursement of Special Cash package in lieu of LTC
Annexure ‘B’
Congingent Bill for Reimbursement of Special Cash package in lieu of LTC | |||
| CDA A/C No | Personal No. | ||
| Officer’s Name | Re- Employed | Yes/No | |
| Marital Status | Married/Unmarried | Spouse Employed (in Armvl | Yes/No |
| Whether spouse availed this scheme | Yes/No | ||
Year | 2020/2021 | ||
| CORPS | Pay Level | ||||
| Basic Pay | |||||
| Are You doctor or not ? | Yes/No | NPA(in Rs.) | |||
| Whether opted for Leave Encashment ? | Yes/No | LTC to be claimed for (yr) | 2020/2021 | |
| No of Persons | Air Fare claimed | No of person XRs 20,000 (Economy) Rs 36,000(Business) | Rs | |
| Name | Relationship | |||
Leave Details | ||||
| No of days already encashed on LTC | Year | No. of Days | ||
| No. of days to be Encashed(Max. 10 days) | DO ll NO …. | RS | ||
| Amount as per lnvoice(in Rs.) | RS | |||
| Amount entitled ( Air fare X3 + Encashment) | RS | |||
| Advance drawn(in Rs.) | Rs | |||
| Balance(in Rs.) | Rs | |||
| Encl : 1. Original Invoice(s) 1,2,3… 2. Proof of Digital payment 3. DO II for encashment | |
Signature | |
| Date: | CDA A/c No. |
Counter signed with Seal
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