BANK OF BARODA

A-5 (Legal size)

CLAIM / PSS
PROFORMA FOR ENCASHMENT OF LTC/LFC BLOCK AND PRIVILEGE LEAVE ENCASHMENT
UNDER BOBOSR / BPS

Name: _________________________________________, EC No: ___________________

Designation:________________________________, Basic Pay : `___________________

Branch/Office:______________________________ ALPHA: _________ SOL ID:_______

E. Mail Address: _____________________________ Ph No.___________VOIP No.: ____

Date: ________________

The AGM/Chief /Sr./Br. Manager,

Bank of Baroda
_________________
_________________
Dear Sir,

Re: Encashment of -2- OR - 4- years LTC/LFC Block,

Period from _______________To _______________ (DD/MM/YYYY)
I have been sanctioned ______days (PL/CL/SL) from ___________to ____________ and want to
encash my abovementioned LTC/LFC block as per the BOBOSR/ BPS and clarifications received
by the bank from time to time.

The details of block and encashment of PL is as under:

1. Last LTC/LFC availed for block period from ____________to__________ (DD/MM/YYYY)

2. Present LTC/ LFC available for block period from ________to_________ (DD/MM/YYYY)

3. The details regarding My self/Family members who are wholly dependent on me are as
under:

Sr. Name Age Relationship Annual Occupation

No. Income/Pension &
` Organisation
where
working.

Kindly sanction me:

1. Encashment of my LTC/LFC block as above

2. Encashment of _________days P/L

I undertake that income of my dependent family members does not exceed the prescribed
limits as per the Bank’s norms.

Yours faithfully,

( )
 A-5 (Legal size)

CLAIM / PSS
FOR BRANCH/OFFICE USE ONLY

Name___________________________________, E.C. No. ________, Designation:___________

The last LTC/LFC availed by the employee was in the year ________ for the block

Period _________________to______________ (i.e. DD/MM/YYYY to be mentioned)

The employee was permitted to encash _____PL days during the year______ (MM/YYYY) and

He/she is now entitled _________days PL for encashment of leave (once in 4 / 2 Years)

Details of his/her entitlement

(A) Encashment of LTC/LFC (B) Encashment of ______days PL

1.Basic `________
Eligibility : Mode of Travel (Railway fare )for: 2. D.A. `________
1.Officers in SMG/S IV & above is AC 1st class 3.HRA `________
2.Officers in JM1/MMG/S II & III is AC 2 tire 4.CCA `________
3.Clerical is II nd class sleeper 5.Special `________
4. Sub-Staff is IInd class sleeper Allowance
6. Edu.(PQA) `________
_________KM Rs.________for 2/4 years block Allowance
7.PPA/FPA `________
` __________x 2 (To & Fro) = `_________ 8.Other `________
` __________x ____Tickets = `_________ Allowance/s
75% of Rs. _________+ Rs.______________ TOTAL `_________
Officiating Allowance, Washing
Eligible Amount of Rs. ________paid on _____ Allowance, Cycle Allowance & Transport
Allowance are not to be considered while
Income Tax deducted Rs.___________ calculating PL encashment.

Recommended by: Sanctioned by Recommended by: Sanctioned by:

Clarifications:
1. Extension of LTC/LFC block is not allowed in case where employee opts to
encash LTC/LFC facility.
2. LTC/LFC for travel to the place of domicile (Home Town) is not encashable.
3. In case of Award staff so encashing the facility of LFC shall proceed on leave
for a minimum period of -1- days.
4. In case of officers any kind of leave including sick leave/ casual leave/
extraordinary leave will hold good for encashment of LTC also. No minimum
period of leave has been stipulated.
Entitlement:
1. Officers up to scale – III : -4- years block 4500 km (one way)

2. Clerical Staff : -2- years block 2000km & -4- years block 4000km (one way)

3. Substaff : -2- years block 2500 km & -4- years block 5000 km (one way)

4. Part Time Sub – staff : (1/3, 1/2, 3/4) ON PRORATA BASIS OF distance.

TO BE USED FOR P.S.S TO BE DONE BY HR SHARED SERVICES BACK OFFICE