APPLICATION FOR AV

Subsihar Rule - 73

N eor Applic nt

2eave Hule applieable

Post held

use e
Canveyiance Allaw.an

rwn in the present mst

Ground on which leave is applied tor

9 Date ol Return from last leave and the nature

nu periou Or suth teave
U. Tundertake to refund the difference between the
LEave salary drawn duting leave on average pay.

aueraee naw/ Half nav eave which

aud hw h
admissible had the provision in FR IH[b}(11)/Rule 121cNn)
ot the revised leave Rules, 193:A not been applied in the event
l my retirement from service at the end or during 1he currency
of the leave.

Date Signature
leave Address

11.Remarks and/ ar recomnendation

of the controlling Officer

Sgature