FORM M

Name of the Employer / Establishment

Name of Employee :

Description of the Department if Applicable : Date of Entry into Service :

Payment of Leave on Discharge of an

Accumulation of Payment of Leave
Leave Allowed Refusal of Leave Employee Quiting Employment if a Signature or
Leave Made on
Admissible Thumb
Balance of
Impression of
Leave
Employee on Remarks
Carried Signature or Receipt of
Over Amount of Date of Left hand
Leave due No of 1st 2nd Date of Date of Date of Leave Book
From To Leave Amount Thumb in Form N
on days Month Month Application Refusal Discharge
Refused Paid Impression of
Employee