Form of Application For Leave: and Date From Which Required

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FORM OF APPLICATION FOR LEAVE

Note: Items 1 to 11 must be filled in by all applicants whether gazetted or non-gazetted.

1. Name of applicant

2 Post held

3 Department, office and section

4 Pay

5 House rent allowance, conveyance,


allowance or 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 Prefix


prefixed/suffixed to leave. Suffix:

8 Ground on which leave applied for.

9 Date of return from last leave, and nature and ---


period of leave ---

10 I propose/ do not propose to avail


myself of Leave Travel Concession for the block years
----------------------------------during the ensuing leave.
10 Availing LTC
11 Address during leave period

12 Date : Signature of
Applicant

13 Remarks and/ or recommendation of the


Controlling officer. Signature________________

Designation________________

Certificate Regarding Admissibility of Leave

14 Certified that __________________________________________ (Nature of leave)


for_______________________from_____________to_____________________ is
admissible under rule ____________of the ____________________CCS Leave
Rules, 1972.

Date__________________ Signature ________________

Designation ________________

15 Order of the sanctioning authority.

Date___________________ Signature_________________

Designation ________________

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