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PART A (TO BE FILLED BY THE GOVERNMENT SERVANT) 1. Emp. Code 3. Designation 2. Name 4. Pay Scale 5. Headquarters 6. Leave Details a) Nature of Leave b) Period 7. Particulars of members of family in respect of whom the LTC has been claimed Sl.No 1 2 3 4 5 6 7 8 Name Age Relationship 8. Details of journey(.

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