Congingent Bill Form for Reimbursement of Special Cash package in lieu of LTC

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 NoPersonal No.
Officer’s NameRe- EmployedYes/No
Marital StatusMarried/UnmarriedSpouse Employed (in ArmvlYes/No
Whether spouse availed this schemeYes/No

Year

 2020/2021

 

 

CORPSPay Level
Basic Pay
Are You doctor or not ?Yes/NoNPA(in Rs.)
Whether opted for Leave Encashment ?Yes/No

LTC to be claimed for (yr)

2020/2021
No of PersonsAir Fare claimed

No of person XRs 20,000 (Economy) Rs 36,000(Business)

Rs
NameRelationship

Leave Details

No of days already encashed on LTCYearNo. 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

Click here to view/download PDF

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