Form No.

13
Application For Leave
Rule 113 Part 1
Note: Item 1 to 16 must be filled in by all applicants whether gazetted or non gazetted
1Name of applicant Mary Margaret V G
2ate of !irth 1"#1$#1%"&
'(ost held Medical )fficer
&epartment* )ffice and +ection Go,t -omoeo isp* .udu//achira
0(ay and +cale (ay 1s#
6ate of entry into ser,ice 2&#1$#2$$0
"ate of commencement of continous ser,ice 2&#1$#2$$0
2
3hether the applicant has got confirmation in any
post* if so from which date and in which post
4es* 2&#1$#2$$"
%5ddress during lea,e
36o 7ude 7ararth . 5*
8hief Manager*
Global 9:change 8o ;;8*
Nizwa* (! No 1&'%* (8 611*
+ultanate of )man
1$
-ouse rent allowance* 8on,eyance allowance or
other compensatory allowances drawn in the pre<post
1s#
11
Nature and period of lea,e applied for and date from
which re=uired
;95V9 3I>-)?> 5;;)35N89 @)1 0
4951+ w#e#f# 11#$"#2$11
12
+undays and -olidays if any purposed to be
prefi:ed6suffi:ed to lea,e
1$#$"#2$11
1'Ground on which lea,e applied for 7oining @amily
1&
ate of return from last lea,e and the nature and
period of the lea,e
2"#11#2$$%* Maternity ;ea,e* 12$ days
10 aA
I underta/e to refund the difference between the
lea,e salary drawn during commuted lea,e and the
admissible during half pay lea,e which would not
ha,e been admissible in the e,ent of my retirement
from ser,ice at the end or during the currency of
lea,e#
10 bA
I underta/e to refund the lea,e salary drawn during
lea,e not due which would not ha,e been admissible
had rule 20 part 1 not be applied in the e,ent of my
,olunary retirement or registration from ser,ice at any
time until earned half pay lea,e not less than the
amount of lea,e not due a,ailed of by me#
16(lace: .udu//achira
+ignature of the applicant with date
1"1emar/s and or recommendation of controlling office
(articulars furnished abo,e has been ,erified
and found correct# -er probation has been
declared w#e#f# 2&#1$#2$$"# -ence sanction
may be accorded
+ignature Bwith dateA C esignation
Note:<
In the case Go,ernment ser,ant who is mentally unsound and or physically unable of fill in the
columns of this form and sign* it* the guardian or his appointed under the India lunacy 5ct 1%12
8entral 5ct IV of 1%12 of any person authorized by the authority competent to grand the lea,e may
fill in the column and sign the application for and on behalf of the Go,ernment +er,ant#
891>I@I85>9 19G51ING 5MI++I!;I>4 )@ ;95V9
B!y 5ccountant General in the case of Gazetted )fficersA
12
8ertified that DDDDDDDDDDD# BNature of lea,eADDDDDDDD @orDDDD#from
DDDDD# >o DDDDDD## Is admissible under ruleDDDDDDDD of the .erala +er,ice
1ule#
+ignature Bwith dateA C esignation
1%)rder of the sanctioning authority
+ignatureBwith dateA C esignation
If the applicant is drawing any compensatory allowance the sanctioning authority should state be on
the e:piry of lea,e be is li/ely to return to the same post or to another post carrying a similar
ad,ance#