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1. - t r j - FORMPLUS A Compilation of Blank Forms used in Central Government Departments. For inclusion, please mail a copy to scorp692003@yahoo.co.in Compiled by T Reji…
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  • 1. - t r j - FORMPLUS A Compilation of Blank Forms used in Central Government Departments. For inclusion, please mail a copy to scorp692003@yahoo.co.in Compiled by T Reji John.
  • 2. - t r j - Sub Bill No.______________ No. 02 Travelling Allowance Bill for Tour Note : This bill should be prepared in duplicate, one for payment and the other as office copy. PART – A [To be filled by the Government Servant] 1. Name of Officer / Official 2. Designation 3. Pay Rs. 4. Head Quarter 5. Details and Purpose of Journey(s) performed As under Departure Arrival Date & Time From Date & Time To Mode of travel & Class of Accommodation Fare Paid Rs. Distance in Kms. 1. 2. 3. 4. 5. 6. 7. Purpose of Journey Performed
  • 3. - t r j - 6. Mode of Journey (i) Air (a) Exchange voucher arranged by office Yes / No (b) Ticket / Exchange voucher arranged by (ii) Rail (a) Whether travelled by Mail / Express / Ordinary Train ? Yes / No (b) Whether return tickets available ? Yes / No Yes / No(c) If available whether return tickets purchased ? If not state reasons. (iii) Road Mode of conveyance used i.e. by Government transport, by taking a Taxi, a single seat in a bus or other public con- veyance, by sharing with another Government Servant in a car belonging to him/her or to a third person to be specified 7. Dates of absence from Place of halt, on account of : (a) Restricted Holiday & Casual Leave (b) Not being actually in camp on Sundays and Holidays 8. Dates on which free Boarding and / or Lodging by the State or any organization financed by State Funds : (a) Boarding only (b) Lodging only (c) Boarding and Lodging 9. Particulars to be furnished along with Hotel receipts etc, in cases where higher rate of D.A. is claimed for stay in hotel/other establishments providing board and/or lodging at scheduled tariffs : Period of Stay From To Name of the Hotel Daily rate of lodging charge Total Amount Paid
  • 4. - t r j - 10. Particulars of journey(s) for which higher class of accommodation than the one which the Government servant is entitled was used : Date Name of Place Fare of the entitled class 71 From 2 To 3 Mode of Conveyance used 4 Class to which entitled 5 Class by which travelled 6 Rs. Ps. Total If the journey by higher class of accommodation has been performed with the approval of the Competent Authority, No. and date of the sanction may be quoted. 11. Details of Journey(s) performed by road between places connected by Rail : Date Name of Place 1 From 2 To 3 Fare Paid Rs. Ps. Total 12. Amount of Advance of Travelling Allowance, if any, drawn Rs. Certified that the information, as given above, is true to the best of my knowledge and belief. [ ] Date : ______________ Signature of the Government Servant
  • 5. - t r j - PART – B [ To be filled in the Bill Section ] The net entitlement on account of Travelling Allowance works out to Rs. ________________ as detailed below : (Amount in Rs.) (a) Railway / Air / Bus / Steamer Fare (b) Road mileage for ______________kms @ ______________ per km. (c) Daily Allowance TimeDate From To Hrs./Min. Stay / Journey Rate of D.A. (d) Actual Expenses : Auto/Taxi/Other (e) Gross Amount (f) Less : Amount of T.A. Advance if any drawn vide Voucher No. __________________dated ________________. (g) Net Amount The Expenditure is debitable to T. A. Account. Signature of Drawing & Disbursing Officer Signature of the Controlling Officer Passed for Payment of Rs. ____________ only. Remarks :
  • 6. - t r j - Sub Bill No.______________ No. 03 Travelling Allowance Bill for Transfer Note : This bill should be prepared in duplicate, one for payment and the other as office copy. PART – A [To be filled by the Government Servant] 1. Name of Officer / Official 2. Designation 3. Pay at the time of transfer Rs. Old4. Head Quarter New Residential Address Old Address 5. New Address 6. Particulars of the members of the family as on the date of transfer : Sr. No. Name of the family member Age Relationship with the Govt. Servant 7. Details of Journey(s) performed by Government servant as well as members of his/her family : Departure Arrival Date & Time From Date & Time To Mode of travel & Class No. of fares Fare Paid Distance in Kms by Road
  • 7. - t r j - 8. Transportation charges of personal effects (Money receipts to be attached) : STATIONDate Mode From To Weight in Kgs. Rate Amount Remarks 9. Transportation charges of personal conveyance ( Money receipt to be attached ) : a. Mode of Transport and Station to which transported b. Amount 10. Amount of advance if any drawn 11. Particulars of journey(s) for which higher class of accommodation than the one to which the Government servant is entitled was used : Date Name of Place Fare of the entitled class 7 1 From 2 To 3 Mode of Conveyance used 4 Class to which entitled 5 Class by which travelled 6 Rs. Ps. TotalIf the journey by higher class of accommodation has been performed with the approval of the Competent Authority, No. and date of the sanction may be quoted. 12. Details of journey(s) performed by Road between places connected by Rail : Date Name of Places From To Fare Paid Certified that the information, as given above, is true to the best of my knowledge and belief. [ ] Date : ______________ Signature of the Government Servant
  • 8. - t r j - PART – B [ To be filled in the Bill Section ] The net entitlement on account of Travelling Allowance works out to Rs. ________________ as detailed below : (Amount in Rs.) (a) Railway / Air / Bus / Steamer Fare (b) Road mileage for ______________kms @ ______________ per km. (c) Transfer Grant (d) Transfer Incidentals (D.A. for ___________ day(s) @ Rs. _________ per day) (e) Transportation of personal effects Calculation: (f) Transportation of private conveyance Calculation: Gross Amount (g) Less amount of advance, if any drawn vide Voucher No. ____________ Dated ________________ Net Amount The Expenditure is debitable to T. A. Account. Signature of Drawing & Disbursing Officer Signature of the Controlling Officer Passed for Payment of Rs. ____________ only. Remarks :
  • 9. - t r j - Form for giving intimation or seeking previous sanction under Rule 18(3) of the CCS (Conduct) Rules, 1964 for transaction in respect of moveable property. 1. Name of the Government Servant 2. Scale of pay and present pay 3. Purpose of application/ sanction for transaction/ intimation of transaction 4. Whether the property is being acquired or disposed off ? a. Probable date of acquisition or disposal of property. 5. b. If the property is already acquired/ disposed off, actual date of transaction. a. Description of the property (e.g. Car/ Scooter/ Motor Cycle/ Jewellery/ Loans etc. 6. b. Make, Model No. and also Registration No., in case of vehicles where necessary. 7. Mode of acquisition/disposal (Purchase/Sale, Gifts, mortgage lease or otherwise) 8. In case of acquisition, source or sources from which financed/ proposed to be financed : (a) Personal Savings (b) Other sources giving details 9. Sale/Purchase price of the property (Market value in the case of gifts) 10. In the case of disposal of property, was requisite sanction/intimation obtained/given for its acquisition ? (A copy of the sanction/ acknowledgement should be attached.) a. Name and Address of the party, with whom transaction is proposed to be made/ has been made. b. Is the party related to the applicant ? If so, state the relationship. c. Did the applicant have any dealings with the party in his official capacity at any time, or is the applicant likely to have any dealing with him in the near future ? d. Nature of official dealings with the party. 11. e. How was the transaction arranged ? (Whether through any statutory body or a private agency/ through advertisements or through friends and relatives. Full particulars to be given.) 12. In the case of acquisition by gifts, whether sanction is also required under Rule 13 of the CCS (Conduct) Rules, 1964 ? 13. Any other relevant fact which the applicant may like to mention.
  • 10. - t r j - DECLARATION I, ___________________________________________________________ hereby declare that the particulars given above are true. I request that I may be given permission to acquire/dispose of property as described above from/to the party, whose name is mentioned in Item 11 above. OR I, ___________________________________________________________ hereby intimate the acquisition/ disposal of property by me, detailed above. I declare that the particulars given above are true. Station : Signature: ___________________ Date : Designation : _________________ Note: 1. In the above form, different portions may be used according to requirement. 2. Where prior sanction is asked for, the application should be submitted at least 30 days before the proposed date of the transaction.
  • 11. - t r j - T. R.-25 G.A.R.-14 [See Treasury Rule 277(1)] [See Rules 66(1) & 90(1)(1)] Consolidated Travelling Allowance Bill of the Ministry/Department/ Office of the _______________________________________________ for the month of _________________, _____________. 1. Bill No. and date 2. Token No. and date 3. Voucher No. & date Head of account Major Head Minor Head 4. Detailed Head 5. (A) Details of T. A. Claims : Sr. No. Sub-Bill No. Name & Designation of Govt. Servant Gross Claim Advance Net Amount Payable Remarks 1. 2. 3. 4. 5. 6. 7. Total (A) (B) Deduct: Undisbursed travelling allowance refunded as per details below. (A-B) Net sum required for payment by - 1. Cheque for self Rs. 2. Cheque in favour of officers as indicated in Column No. 3 Rs. 3. Cheque/Bank Draft in favour of Rs. Appropriation for the F. Y. Rs. Expenditure including this bill Rs. Balance Rs.
  • 12. - t r j - Passed for payment of Rs. ______________/- (Rupees _____________________________________________ _____________________________________________________________________ only) Certified that the claims included in the bill have not already been paid and office copies of the sub-bills have been suitably cancelled to avoid double payment. Received Contents Drawing and Disbursing Officer 6. (B) Details of undisbursed T. A. refunded Bill No./Sub-bill No. and date Name and designation of Govt. Servant Amount (Rs.) Total Drawing and Disbursing Officer For use in Pay and Accounts Office Pre-check enfacement Pay Order Pay Rs. _____________/- (Rupees ______________________________________________________________________ only) to _____________________________________________(D.D.O. by designation/vide details given in the bill) by ______________ Cheque/Bank draft after disallowing Rs. _________________ (for reasons to be communicated) No. and date of cheque delivered _________________________________________________. J.A.O. P.A.O. Post-check of vouchers received from cheque drawing D.D.Os. Post check of pre-checked vouchers Admitted Rs._________________________. Objected Rs. _________________________. (With brief reasons) J.A.O. P.A.O. J.A.O. P.A.O. Note: 1. Claims for journeys on tour and transfer should be grouped and shown separately in the consolidated bill. L.T.C. claims are to be drawn on separate bills, as these payments are chargeable to the head “Salaries”. 2. Objections, if any, on individual claims be got settled by personal contact on phone or otherwise as far as possible. On cases where delay is anticipated, the affected claims may be ignored and the bills passed for payment in respect of other claims found in order.
  • 13. - t r j - Form T.R. 27 – A (See Rule 281 A) Medical charges Reimbursement bill (Non Gazetted) Establishment. Bill No. Voucher No. for ______________________ Detailed Medical Bill of the Establishment of the ____________________________________ ___________________________________________(specify Head of Office/Department) for the month/s of _________________________. Head of Account : Grant No.: Major Head : Appropriation Group Head Detailed Head : Voted Charges : Sr. No. Section or Establishment and Name of the incumbent Gross Claim Recovery of Advance Net Amount Payable Remarks 1 2 3 4 5 6
  • 14. - t r j - Certified that I have satisfied myself that the amount included in bills drawn 1st /2nd months/3rd months previous to this date with the exception of those detailed below (of which the total amount has been refunded by deduction from this bill) have been disbursed to the Government servants therein named and their receipts taken in the office copy of the bill or in a separate acquaintance roll. Details of Medical Charges refunded PeriodSection of establishment and name of incumbent From To Amount Appropriation for the year _______________. Rs. Expenditure (including this bill) Rs. Balance Rs. Passed for Rs. ________________________ Signature of the Controlling Officer Station : Date : Received Contents Examined & Entered Treasury Accountant Signature of the Drawing Officer Date : Pay Rs. __________________ For Use in the Audit Office Admitted for Rs. Objected to Rs. Reasons for the objections : Auditor Superintendent (Gazetted Officer) Signature of the Drawing Officer
  • 15. - t r j - APPLICATION FOR GRANT OF FESTIVAL ADVANCE 1. Name of applicant (in capital) Shri /Smt. / Kum. 2 Designation 3 Section to which attached 4 Particulars of Permanent / Quasi-permanent post held, if any. If temporary a. Whether surety bond from another Govt. Servant has been attached 5 b. Particulars of the surety 6 Present Pay excluding Allowances Rs. 7 Amount of advance required Rs. 8 Festival for which advance is applied for 9 If on leave, specify the nature and particulars of leave. 10 Whether the applicant has drawn any festival advance earlier during the current calendar year. Yes / No / N.A. 11 Whether any festival advance drawn in the previous calendar year has been fully recovered or not. If not, give particulars. 12 Whether advance for Government sponsored trip in hill station has been taken during the current year. Yes / No / N.A. I certify that the facts stated above are true to the best of my knowledge and belief. Signature of the applicant with date Section.
  • 16. - t r j - Sub Bill No.______________ No. 04 Leave Travel Concession Bill For the Block Year ___________ to ____________ Note : This bill should be prepared in duplicate, one for payment and the other as office copy. PART – A [To be filled by the Government Servant] 1. Name of Officer / Official 2. Designation 3. Pay Rs. 4. Head Quarter 5. Nature and period of leave sanctioned E. L./C.L./E.O.L./R.H. from : _________ to _________ 6. Particulars of members of family in respect of whom the LTC has been claimed. Sr. No. Name Age Relationship with the Govt. Servant. 7. Details of Journey(s) performed by Government Servant and the members of his/her family : Departure Arrival Date & Time From Date & Time To Distance in Kms. Mode of travel & Class of Accommo- dation No. of Fares Fare Paid Rs. 1. 2. 3. 4. 5. 6. 7. 8. Remarks /Ticket Nos 8. Amount of Advance, if any drawn… Rs.
  • 17. - t r j - 9. Particulars of Journey(s) for which higher class of accommodation than the one which the Government Servant is entitled, was used (Sanction No. & date to be given). Place From To Mode of Conveyance Class to which entitled Class by which actually travelled No. of fares Fare of the entitled class. 1 2 3 4 5 6 7 10. Particulars of Journey(s) performed by Road between places connected by Rail. Name of Place From To Class to which entitled Railway Fare 1 2 3 4 Certified that the : 1. Information as given above is true to the best of my knowledge and belief, and 2. The my wife/husband is not employed in Government Service/ that my wife/husband is employed in Government Service and the concession has not been availed of by her/him separately for herself/himself or for any of the family members for the concession block of _______________ years. Signature of the Government Servant Date ______________________
  • 18. - t r j - PART – B [ To be filled in the Bill Section ] The net entitlement on account of Leave Travel Concession works out to Rs. ________________ as detailed below : (a) Railway/Air/Bus/Steamer Fares (b) Less : Amount of Advance drawn vide Voucher No. Dated (c) The Expenditure is debitable to Account. Net Amount Rs. Initials of the Bill Clerk Signature of Drawing & Disbursing Officer Signature of Controlling Officer Certified that necessary entries have been made in the Service Book of Shri/Smt./Miss. ________________________. Signature of the Officer authorised to attest entries in the Service Book.
  • 19. - t r j - APPENDIX - I [Certificate to be given by the Controlling Officer] Certified that : 1. Shri/Smt./Kum. _____________________________________________ has rendered continuous service for one year or more on the date of commencing of outward journey. 2. Necessary entries as required under para (52) of the scheme have been made in the Service Book of Shri/Smt./Kum. _________________________________________________. 3. Para 1(6) of MMA O.M. No. 43/1/55.Est.(A).Pt.II dated 11th October, 1956. Signature of the Controlling Officer [Certificate to be given by a Government Servant] 1) I have not submitted any other claim so far for Leave Travel Concession in respect of myself or family members for the Block Year ____________________. 2) I have already drawn T.A. for the Leave Travel Concession in respect of a Journey performed by me/with my spouse/ with children. This claim is in respect of the journey performed by my spouse/ myself with my spouse/ and/or children / none of whom travelled with the pary on the earlier occasion. 3) The journey has been performed by me and my spouse with children to the declared “Home Town” / Other than Home Town viz. ____________________. 4) That my spouse is not employed in Government Service and the concession has not been availed of by him/her separately for himself/herself or for any other family member of the concerned block of two years. 5) Certified that my spouse for whom Leave Travel Concession is claimed by me is not employed in any Public Sector Undertaking/ Corporation/ Autonomous Body financed wholly or partly by the Central Government or a local body which provides LTC facilities to its employees and their families. Signature of the Govt. Servant.
  • 20. - t r j - APPLICATION FOR ADVANCE FROM PROVIDENT FUND 1 Name of the subscriber 2 Account No. 3 Designation 4 Pay Balance at credit of the subscriber on the date of application as below i) Closing balance as per statement for the year ___________ . ii) Credit from March ________ to ________, _______ on account of monthly subscription. iii) Refund. iv) Withdrawals during the period from __________ to ___________. 5 v) Net Balance at credit. 6 Amount of advance / outstanding if any, and the purpose for which advance was taken. 7 Amount of advance required a. Purpose for which the advance is required. 8 b. Rules under which the request is covered. 9 Amount of the consolidated advance (Items 6 & 7), number of monthly installments in which consolidated advance is proposed to be repaid. 10 Full particulars of the peculiar circumstances of the subscriber, justifying the application for the advance. Signature:_____________ Name :_______________ Designation :___________
  • 21. - t r j - PROFORMA FOR APPLICATION FOR WITHDRAWAL FROM PROVIDENT FUND Ministry of : Department of : Office : 1 Name of the subscriber 2 Account No. 3 Designation 4 Pay 5 Date of joining and date of superannuation. Balance at credit of the subscriber on the date of application as below i) Closing balance as per statement for the year ___________ . ii) Credit from March ________ to ________, _______ on account of monthly subscription. iii) Refund made to the fund after closing balance vide ( i ) above. iv) Withdrawals during the period from __________ to ___________. 6
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