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H.31TT.

1
S.R.-1

FORM OF APPLICATION FOR LEAVE


(3M3T AH 216 èfet) (See Supplementary Rule 216)

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


1. T - IName of Applicant
2.
Leave rules applicable

3. Post held-
4.
Department, Office and Section-

5. da Pay-
6.

House rent allowance, conveyance allowance or


other compensatory allowances drawn in the present post. .

7.
Nature and period of leave applied for and date from which required.
8.
Sunday and holidays, if any proposed to be prefixed / suffixed to leave.

. R T IGround on which leave is applied for

Date of return from last leave, and the nature and period of that leave.

11. f a r TAg a . sanseceee********eso*


I propose l do not propose to avail myself of leave travel concession in the block years...
during the ensuing leave.

12.

**Ag RA¥sAn 81 (a)(i)/*fra ga Aa, 1993 fm 11 () ( ii }a

(a) I undertake to refund the difference between the leave salary drawn during leave on
average pay/ commuted leave and that admissible during leave on half averagepay! hatf
pay, leave, which would not been admissible had the provison to FR. 81 (i) rule (i) of
the Revised Leave Rules, 1933 not been applied in the event of my retirement from
service at the end or during the currency of the leave.
l undertake to refund the leave salary drawn during leave not due which would not have been
(b) admissible had F.R. 81 (c) Rule Il (d) of the Revised Leave Rules 1933 not been applied, in
the event of my voluntary retirement or resignation from service at any time until l earn half
of by
pay leave not less than the amount of leave not due availed
me.

Date **********
Signature of Applicant....

13.
Remarks and / or recommendation of the Controlling Officer.

TN/Date ***°****°********°*****" FTR/Signature..


TE14/Designation...

cERTIFICATE REGARDING ADMISSIBILITY OF LEAVE

(By Accountant General in the case of gazetted officers)

14. *************
**************** ***********************e********e********e********sse**

*°°e°*°°*°**°*°°*°**°°°** ******o****** *****°* **s0o***esseooo*****i*

. e .****e***** ******oea. ) aTREI


Certified that . . *eeoee***************** ***e**** Nature of Leave)

for * Om.....*.e*aseroesoavessssooroo**i..lO.aus..

is admissible under rule .....of the.. Rules.

O/Date. ° * * * * * * * * * * * ° ° ° ' * °
FI/Signature....************"
T4H/ Designation..

15.
Order ofthe sanctioning authority

N /Date.. .*************** ** IR/Signature...


EA/Designation.

If the applicant is drawing any compensatory allowance, thesanctioning authority should state
whether on the expiry of leave he is ikely to return to the same post or to another post carrying a
similar allowance.

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