Prefilled LTC Form For Haryana Govt. Employees (Download PDF)

Application For LTC - Fill, Edit To Download PDF

Enter Employee Name:


Enter Father/Husband Name:


Enter Employee ID:


Enter Designation:


Enter Place of Posting, Block, District etc.:


Enter Designation of Head Of Office/DDO:


Enter School/Office Name, District, State:


Enter Joining Date:


Enter Superannuation/Retirement Date:


Enter Your Date of Birth:


Enter Your Pay Level:


Enter Basic Pay:


Enter DA %:


DA Amount (Basic Pay × DA % / 100):


LTC Amount (Basic Pay + DA Amount):


Select Period of LTC:
Select 01-01-2024 To 31-12-2027 01-01-2020 To 31-12-2023

Select Block Years:
Select 2024-2027 2020-2023

Enter Visiting Place(s):


Enter Your Contact Number:


Is Your Spouse a Govt. Employee? Select Yes or No:
Select Yes No

Name of Spouse:


Designation of Spouse:


Office/Department of Spouse:


Employee ID of Spouse:


Joining Date of Spouse: