Application For Leave or Extension of Leave

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SR-I

Application for Leave or Extension of Leave

1. Name of the applicant :

2. Post held :

3. Department, Office and Section :

4. Pay :

5. House rent and other compensatory


Allowance drawn in the present post :

6. Nature and period of leave applied for


and date from which required :

7. Sundays & Holidays, if any proposed to


be prefixed/suffixed to leave :

8. Grounds on which leave is applied :

9. Date of return from last leave and the


Nature & period of that leave :

10. I propose/do not propose to avail myself


LTC for the block years………. During
The ensuing leave :

11. Address during the leave period :

Date ……………………….. Signature of the Applicant

12. Remarks and / or recommendations of


The Controlling Officer :

Signature & Designation

CERTIFICATION REGARDING ADMISSIBILITLY OF LEAVE

13. Certified that ……………………………………………. (Nature of Leave) for ………… days


from ……………. To ……………………. is admissible under rule ………………………… of the
CCS (Leave) Rules 72.

Orders of the authority competent to


Grant leave :

Signature & Designation

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