Leave Requisition Form: Employee Name Designation Department

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LEAVE REQUISITION FORM

Employee Name

Employee Code

Designation

Department

LEAVE REQUEST DETAILS


From (Date)

To (Date)

Morning

Evening

No of Days Applied
IF HALF DAY

Date:

Reason for Applying

Leave
(If Leave is sanctioned)

Contact Address/ Tel


No.during Leave

Date:

Address :
Tel No.

(STD code)

No

Employee Signature

------ --

- - - - -

LEAVE Recommended / Sanctioned

Substitute Arranged:

(for Leave more than 3

days)
Name

LEAVE NOT Recommended


Leave can not be allowed for the following
reason

Designation:
Leave Allowed for

Days

From:

To:

Immediate Manager
Signature

HOD
Signature

I mmediate Manager Signature

------- ------- TO BE COMPLETED BY HR SECTION

Leave Balance;

(as on date)

Last Leave availed


Leave adjusted against balance
leave

Date:

Leave adjusted against salary


deduction

HR Representative
Signature

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