FORM 1

[See Rule 14]

APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE

1.
2.
3.
4.
5.

6.
7.
8.
9.
10.
11.

Name of applicant :
Post held:
Department, Office
and section :
Pay :
House rent allowance/Conveyance
allowance or other compensatory
allowances drawn in the
present post :
Nature & period of
leave applied for and date
from which required :
Sundays and holidays
if any proposed to be
prefixed/suffixed to leave:
Ground on which leave
is applied for :
Date of return from last leave and the nature
& period of that leave :
I propose/do not propose to avail myself of
Leave Travel Concession for the block
during the ensuing leave. :
Address during leave period ( with Phone No.):

Signature of applicant
(With date)
12. Remarks and-or recommendation of the controlling Officer.
Signature (with date)
Designation.
CERTIFICATE REGARDING ADMISSIBILTY OF LEAVE
13.
Certified
that
...
[Nature
of
leave]
for....................[period] from
. to
.is admissible under rule of the
Central Civil Services (leave) Rules, 1972.
Signature (with date)
Designation.
14. Orders of the authority competent to grant
leave
Signature (with date)
Designation.

JOINING /DEPARTURE REPORT

Date:
.

Name :

Designation

Office & Section

Nature of Leave

5. Period of Leave

6. Purpose of leave

7. Date of Joining/ Departure:

JOINING /DEPARTURE REPORT

1. Name

Designation

Office & Section

Nature of Leave

5. Period of Leave

6. Purpose of leave
Signature of Applicant:
.

7. Date of Joining/ Departure:

Signature of Applicant:
.
Date:
.