Self-declaration certificate for completion of Journey on Tour or LTC: DoPT Order

Self-declaration certificate for completion of Journey.

(Annexure to O.M. No. 19024/03/2021-E.lV dated 31st December.2O2l)

1. I (Name of the employee.... ... .......... .....) hereby declare and certify that :

2. lhaveactually performed the onwardjourneyfrom.....-..... ... . . .. . ... .. . . to

. ...........on......................(date) and return journey

from.........................................to.. ......... on.................. tor

the purpose of Tour/Training.

OR

3. I sure have actually performed the onward journey

from... ... ...... ... ... ... . -.... ... ... .. to

.............on......................(date) and return journey

from..........................................to...... ...........on..................for the purpose of Transfer/LTc/Retirement. The particulars of the self and family members who have performed journey either with the Government servant or separately are as under:

4 ln case the above declaration given by me is not found true at any stage, I shall be liable to disciplinary action under Central Civil Services (Classification, Control and

Appeal) Rules, 1965, as amended from time to time.

(Signature)

Name of the Government servant

Designation

Name of the Ministry/Department.

To

Admn/Establishment Section

Ministry/Department....

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