THE SECOND SCHEDULED

{See Rule 3(h)}

FORM

(See rule 14)

 

APPLICATION FOR 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 applied for and date from which required:

 

7.

Sunday and holidays, if any, proposed to be prefixed/ suffixed to leave:

 

8.

Ground on leave is applied for.:

 

9.

Date of return from last leave and the nature and period of that leave:

 

10.

I propose, do not propose to avail myself of leave travel concession for the block years during the ensuing leave:

 

 

11.

Address during leave period:

 

 

 

 

 

 

 

 

Signature of Applicant

With Date

 

12.

Remarks and / or recommendation of the Controlling Officer.:

 

 

 

 

 

 

 

 

Signature (With Date)

 

Designation