THE SECOND SCHEDULE

( See Rule 3-G,14)

FORM-1
APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE

1. Name of Applicant :

2. Post held ::

3. Department/Office and Section ::

4. Pay ::

5. House Rent and other compensatory

allowances drawn in the present post ::

6. Nature and period of leave applied for

and date from which required ::

7. Sunday & Holidays, if any, proposed

to be Prefixed/suffixed to leave ::

8. Ground on which leave applied for ::

9. Date of return from last leave, and the

nature and period of that leave ::

10. I, proposed/ do not proposed to avail myself

Of leave travel concession for block
Year________ during the ensuing leave ::

_______________________________
Signature of Applicant
(With date)

11. Address during leave period-

12. Remarks and/or recommendation of the

Controlling Officer ::

Signature (with date) _____________________

Designation_____________________________
 APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE

1. Name of Applicant : SAMIRAN CHAKRABORTY

2. Post held :: Panchayat Secretary.

3. Department/Office and Section :: Panchayat Department, Charilam R.D. Block.

4. Pay :: Rs. 36,100/-

5. House Rent and other compensatory

allowances drawn in the present post :: As admissible.

6. Nature and period of leave applied for

and date from which required :: 06 (six) days Earned leave
w.e.f. 05/08/2021 to 10/08/2021.

7. Sunday & Holidays, if any, proposed

to be Prefixed/suffixed to leave :: Prefixed & Suffixed holiday – NIL.

8. Ground on which leave applied for :: Family affairs.

(Annual funeral ceremony of father).

9. Date of return from last leave, and the

nature and period of that leave :: -

10. I, proposed/ do not proposed to avail myself

Of leave travel concession for block
Year________ during the ensuing leave ::

_______________________________
Signature of Applicant
(With date)
11. Address during leave period- Siddhi Ashram, Agartala.

12. Remarks and/or recommendation of the

Controlling Officer ::

Signature (with date) _____________________

Designation_____________________________