APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE

Name of applicant:

______________________________________

2.

Post held:

______________________________________

3.

Section(s) where employed:

(Kindly mention all sections)

______________________________________

4.

(a) Nature of leave applied for:

Casual/ Compensatory/ Earned/ Half pay/ RH/

#Commuted/ Leave not due/ Maternity leave/
Paternity leave/ CCL/Child adoption leave/
Extraordinary leave/ / Special disability leave/
Study leave/ Leave preparatory to retirement

(b) Duration of leave:

from_________________to_______________

(c) Period of leave:

______________________________________

(d) Saturdays, Sundays and holidays,

if any, proposed to be:
(i) prefixed to leave

______________________________________

(ii) suffixed to leave

______________________________________

5.

Grounds on which leave is applied for:

6.

EL/HPL at credit:

______________________________________

______________________________________
(Individual leave account may be assessed from PAMS)

7.* I propose/ do not propose to avail LTC for the block years ________________________
for self and/or family during the ensuing leave.
8.

Address & Contact Number during

leave period:

______________________________________

Signature of applicant
(with date)
*In case LTC is proposed to be availed, proforma for availing LTC and / or for availing Advance must
be enclosed along with leave application.
# Medical Certificate should invariably be enclosed with the leave application for commuted leave and
Fitness Certificate needs to be submitted while resuming duty.
9. Remarks and/or recommendations of the Controlling Officer(s) [where an officer is working
under more than one Controlling officer, the leave must be recommended by all Officers
concerned].