LEAVE APPLICATION / MEDICAL LEAVE FORM NAME: STAFF NO:_, DESIGNATION: DEPARTMENT: _ Type of leave [please tick the appropriate box) Dvecation eave LD) worayteave Lp maternity / Paternity Dy Sick Leave LD) Emergency eave) Hospitalization Leave C1] marriage teave Licompensatory time of C] compassionate eave] Protong ness Leave (C] Examination teave From tea of working days _ _ Reason Contact Address & Te! No. During Leave: ‘Annual Leave Record No. of Days = — | Name and Signature of Applicant ate | Leave Credit from last year Received & Recorded by: = Name and Signature of immediate Superior T Date Les: lave taken to date — Approved / Not Approved Balance Leave Available Head of Department Les: leave applied for Date: __ Remarks tnt approved) New leave balance | REARS eg ee Verified by People Department ate 1 Yourmedica leave must be submites to your partment Head nt than 48 hours from the date o! the MC 2 The medial cetiieate [st must be submitted with ii eave orm 3. ry atach etevant documents to support aloes leave