LTA Claim Form
LTA Claim Form
LTA Claim Form
1. Employee ID :
2. Employee Name :
3. Designation :
4. Date of joining :
This is to declare that I have undertaken journey as per the details mentioned herein
Relation Copy of
with the Places visited Dates of journey Class/No.of
Name of the Mode of ticket/receipt
employee kms.in case
person travelling travel No.
of car/taxi
(Yes or No)
Origin Destination From To
I hereby declare that I have incurred a total expense of Rs. ____________ and attach the copies of
relevant tickets / receipts.
______________________
Date : Signature of the employee