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NATIONAL CENTRE FOR RADIO ASTROPHYSICS
TATA INSIITUTE OF FUNDAMENTAL RESEARCH
PUNE UNIVERSITY CAMPUS, PUNE-411007

LEAVE TRAVEL CONCESSION SCHEME
Application for Addition/Deletion of names of family members

(To be filled by the staff member in duplicate and returned to the Establishment Office. Declaration in respect of family member/s made at items 6 below should be supported by some documentary evidence such as copy of ration card, marriage certificate and birth certificate/s of children, broters and sisters.

1. Name & Computer Code:
2. Desingation & Section:
3. Date of Birth:
4. Date of Joining:
5. PB(1/2/3/4/5)-Band Pay-Grade Pay:
6. Names of Family members :
(i.e. wife/husband, children, parents, sisters and minor brothers. Pleasee see note below.)
Sr. No. Name Relation Age Monthly*
income
1
2
3
4
5
6
*If drawing pension, please mention only basic pension and attach documentary proof.

Date :                                     Signature :

Note:
1. 'Family' means a Government servant's wife/husband, unmarried children or stepchildren, wholly dependent upon the Govt. servant whether they are residing with the Govt. Servant or not. Married daughters, who have been divorced, abandoned or separated from their husbands, if residing with or wholly dependant upon the Govt. servant. Unmarrried minor brothers, unmarried divorced, abandoned, separated from their husbands or windowed sisters residing with the wholly dependant on the Govt. Servant provided their parents are either not alive or are themselves wholly dependant on the Govt. Servant.
2. Income from all sources in case of each dependant should not exceed Rs. pm.

For Office Use
The above particulars have been verified with office records and found to be correct. copies of the ration card, marriage certificate and birth certificates of children, brothers and sisters are placed in the file. Establishment Officer may kindly see.

Signature: