Application Form For Earned Leave or Extension of Leave
Application Form For Earned Leave or Extension of Leave
Application Form For Earned Leave or Extension of Leave
1. Name of applicant :
2. Post held :
3. Department, Office and Section :
4. Pay :
5. House Rent and other Compensatory :
allowances drawn in the present post
6. Nature and period of leave : Earned Leave/Commuted Leave
7. Number of Days & date from which the leave Number of Days:
FROM TO
required
8. Sunday, and holidays, if any proposed to be : PREFIX:
prefixed/suffixed to leave SUFFIX :
9. Grounds on which leave is applied for :
10. Date of return from last leave and the nature :
and period of that leave
11. I propose/do not propose to avail myself of :
leave travel concession for the block
years___________________________
12. Address during the leave period :
Signature of applicant
Phone No.
(With date)
13. Remarks and or recommendation of the Controlling Officer.
Signature/Designation
(With date)
CERTIFICATE REGARDING ADMISSIBILITY OF LEAVE
14. Certified that ____________________ for (Nature of Leave) ___________________
(period) from________ to______________ is admissible under Leave Rule 7.21 of
CSKHPKV Statutes 1988.
Signature/Designation
(With date)
15. Orders of the competent authority to grant leave
Signature/Designation
(With date)
-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.
If the applicant is drawing any compensatory allowance, it should also be indicated in the orders on the
expiry of leave, the Government serving similar allowance.
For Office Use Only:
Opening Balance of Leave =Days
Leave earned from to =Days
Total Leave Credit =Days
Leave Applied/Taken =Days
BALANCE on return from Leave =Days