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E.L. Form For West Bengal

This document is an application form for requesting leave from employment in West Bengal. It contains 15 items that must be filled out to apply for leave. The first 10 items require information from all applicants such as name, post held, type of leave requested. Items 12-14 apply only to certain types of employees. Item 12 is for gazetted officers, items 13-14 are for non-gazetted officers and require statements of previous leave granted. The applicant signs to agree to terms, then it is sent to the controlling officer for recommendation and signature before a final decision by the sanctioning authority.

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Debashis Chakraborty
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3K views2 pages

E.L. Form For West Bengal

This document is an application form for requesting leave from employment in West Bengal. It contains 15 items that must be filled out to apply for leave. The first 10 items require information from all applicants such as name, post held, type of leave requested. Items 12-14 apply only to certain types of employees. Item 12 is for gazetted officers, items 13-14 are for non-gazetted officers and require statements of previous leave granted. The applicant signs to agree to terms, then it is sent to the controlling officer for recommendation and signature before a final decision by the sanctioning authority.

Uploaded by

Debashis Chakraborty
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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West Bengal Form No.

2395

APPLICATION FOR LEAVE


Note- Items 1 to 10 must be filled in by applicants, whether Gazetted or Non-Gazetted.
Item 12 applies only in the case of Gazetted Officers.
Items 13 and 14 apply only in the case of Non-Gazetted Officers.

1.

Name of applicant

2.

Leave Rules applicable

3.

Post held

4.

Department or Office

5.

Pay

6.

House allowances, 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.

Grounds on which leave is applied for

9.

Date of return from last leave, and the nature and


period of that leave.

10.
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 average pay/ half pay leave which would not
have been admissible had the proviso to (rule 181
(b)/ rule 172(e)(iii) of the W.B.S.R. Pt I) not been
applied in the event of my retirement from service at
the end or during the currency of the leave

I undertake to refund the leave salary drawn during


b) leave not due which would not have been admissible
had the rule 184 ( c )/ 173 0f W.B.S.R.Part I not been
applied in the event of my retirement from service at
the end or during the currency of the leave.

Dated.200
11. Remarks and or recommendation of the Controlling officer:-

Signature of Applicant

Date200

Signature
Designation:

12. Report of the Audit Officer:-

Date200

Signature
Designation:

P.T.O.
(2)

13. Statement of leave granted to applicant previous to this application :Nature of leave
Privilege/on average pay/Earned

In current year

During past year

Total

...

On average pay on M.C./ Commuted


On half average pay/ half pay

Not due

On quarter average pay

Extraordinary

Total

14. Certified that leave on average pay for Earned


leave/
leave for
months and
days from 200__ to 200___ is
admissible
under article/ rule
of

Date ..01.

Signature
Designation .

15. Orders of the Sanctioning Authority :-

Date.
Signature
Designation
If the applicant is drawing any compensatory allowance, the Sanctioning Authority should state whether on the expiry of
leave he is likely to return to the same post or to another post carrying similar allowance.

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