Leave Application Form

Employee Details:

Name of Employee: ________________________________________________________________

Employee ID #: __________________ Designation: _____________________________________

Department: ______________________________________________________________________

Leave Period:

From: ____/____/_______ To: ____/____/_______  Casual  Sick  Earned  In Lieu of  Without Pay

Reason: ___________________________________________________________________________

Comments (To be filled by Reporting Authority):

1. Work in absence of the staff, assigned to other:  Yes  No

2. Approval granted for leave:  Yes  No

Additional Remarks / Comments:

______________________________________________________________________________________________

______________________________________________________________________________________________

___________________ ____________________________________
Applicant’s Signature: Applicant Reporting Authority’s Signature
Date: ___/___/______ Date: ___/___/______

Note:
1. Leave application should be submitted to the Human Resource Department duly signed by the concerned HOD before
availing the leave. In case of emergency, application must be submitted immediately after joining the duty.
2. Kindly note that if application is NOT submitted on time, salary will be deducted accordingly.
3. In case of more than one Medical leave, medical certificate should be submitted along with Leave application.