Ref. No. HRM-VII-F-02-REV.

0
SICK LEAVE APPLICATION FORM
Name

Designation

GAEC No.

Job No.

Leave date(s)

Type of Illness (If on site injury, attach

:
FIR copy)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Whether consulted doctor? If so, attach
:
Doctors certificate (Doctors certificate
Compulsory for more than 2 days sick leave)
Signature of Employee
Approved/Not Approved

Date :

Divisional Head/HOD/Project Manager

Office Use
Number of SL availed during the year :
Number of sick leave eligible :
Present sick leave :
Balance :
Entered in Sick Leave Register On :

HR Assistant

HR Manager