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Declaration

Leave Travel Allowance (LTA) Declaration

A declaration submitted to the employer to claim exemption on Leave Travel Allowance for travel undertaken within India.

DECLARATION FOR LEAVE TRAVEL ALLOWANCE EXEMPTION

Submitted to [Employer / Company Name] for claiming LTA exemption under section 10(5) of the Income-tax Act, 1961.

I, [Employee Name], Employee Code [Employee ID], holding PAN [PAN Number], do hereby declare as under:

I hereby declare that I, along with my eligible family members, namely [Names & Relationship of Family Members], undertook a journey within India from [Origin] to [Destination] on [Date of Journey] by [Mode of Travel - Air / Rail / Road]. The total travel expenditure incurred amounts to Rs. [Amount], in respect of which I claim exemption under Leave Travel Allowance for the block year [Block Period].

I confirm that this claim is made in accordance with the applicable rules and I enclose the supporting tickets and travel bills. The particulars stated above are true and correct.

_____________________
[Signature of Employee]
[Name]
Place: [Place]    Date: [DD/MM/YYYY]

Before you use it — fill in / check

  • Employee Name
  • PAN Number
  • Journey From/To
  • Date of Journey
  • Travel Expenditure
  • Block Period

How to use this template

  1. Read through and replace every [bracketed] or blank placeholder with your actual details.
  2. Delete any clause that doesn't apply and add anything specific to your situation.
  3. Click Print / Save as PDF to download, or Copy text to paste into your letterhead.
  4. Get it signed / stamped / notarised as required, and keep a copy for your records.

This is a general, editable template for convenience only — not legal advice. For anything material, have a professional review it. TaxClue isn't liable for how it's used.