INDIAN INSTITUTE OF ENGINEERING SCIENCE AND TECHNOLOGY, SHIBPUR

Application of Leave /----------------------------------------

Extension of Leave for
Earned Leave/ ------------------------------------------------------------------
Half-Pay Leave/ Commuted Leave
To: Dean, Faculty Affairs / Dean, Administrative Affairs
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1. Personal File No.: 3. Designation : Associate Professor

Dr. Prithwish Kumar Das 4. Department : Aerospace Engineering & Applied Mechanics
2. Name :
5. Telephone No.: 9433429156

6. Leave applied for: From : 21/03/2018 To : 23/03/2018

7. Nature of Leave: Earned Leave 8. Purpose : Extended Medical Checkup for Family Member

Last Leave availed Earnrd Leave: 22/11/2017 to 24/11/2017 (Three days)

Joind on: 27/11/2017 forenoon
(including Date of
9. Availing L.T.C.
Joining and Nature
of Job) :
Whether Station Leave If yes, mention
10. No
required (Yes / No) (India / Abroad)

11. Address during Leave : 53/A Harish Mukherjee Lane, Bhadrakali, Hooghly - 712232

Signature of the Applicant

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The absence of the incumbent will not hamper the normal works/classes of the Department/School/Center concerned.*

Signature of Head of the Department/In-Charge of Section

-----------------------------------

* not applicable for leave on Medical Ground

(To be used in Administration Section)

The following leave is due on :

Following leave on the basis of the recommendations of the Head of Department/In-charge of Section may be sanctioned.

Balance of Leave : EL ► HPL ►

Sr. Superintendent / Assistant Registrar Dealing Assistant

Dean, Faculty Affairs / Dean, Administrative Affairs

Designed by Arindam Banerjee, Jr. Assistant