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Leave Application PDF

This document is an application for leave form that contains 15 items/sections of information to be filled out depending on whether the applicant is gazatted (items 1-12 and 15) or non-gazatted (items 1-9 and 13-15). For gazatted officers, the form requests information on name, post, department, pay, nature and period of leave applied for, grounds for leave, date of last leave, undertaking to refund pay if retiring during current leave, recommendation of controlling officer, and audit officer's report. For non-gazatted officers, it additionally requests a statement of previous leave granted and certification of earned leave admissibility. The sanctioning authority's orders are required in item 15

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Fayaz Khan
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142 views

Leave Application PDF

This document is an application for leave form that contains 15 items/sections of information to be filled out depending on whether the applicant is gazatted (items 1-12 and 15) or non-gazatted (items 1-9 and 13-15). For gazatted officers, the form requests information on name, post, department, pay, nature and period of leave applied for, grounds for leave, date of last leave, undertaking to refund pay if retiring during current leave, recommendation of controlling officer, and audit officer's report. For non-gazatted officers, it additionally requests a statement of previous leave granted and certification of earned leave admissibility. The sanctioning authority's orders are required in item 15

Uploaded by

Fayaz Khan
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Gazatted Non Gazatted

APPLICATION FOR LEAVE


Notes: Items 1 to 9 must be filled in by all applicants whether gazatted or non-gazatted
Items 10 applies only in the case of applicants subject to the ordinary leave rules
under the F.R who apply for leave on average pay on medical certificate or an extension
of that leave under the provision to R.R. 81 (b)(ii)
Item 12 applies only in the case of gazatted officers.
Items 13 and 14 apply only in case of non-gazatted officials.

1 Name of applicant
2 Leave Rules applicale
3 Post held
4 Department or Office
5 Pay
6 House allownace, conveyance allowance
or other compensatory allowance
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 I undertake to refund the difference


between average pay and half average
pay for the period of leave on average
pay which would not have been admissible
had the provision to R.R 81(b)(ii) not
been applied in the event of my
retirement from service at the end or
during the currency of the leave.
and Signature of applicant
11 Remarks and / or recommendation of the controlling officer

Dated: Signature

12 Report of the Audit Officer Designation

Dated: Signature
13 Statement of leave granted to applicant previous to this application:
Nature of leave _________ in current year ________ During past year ________ total _________
Casual __________________________________ Privilage_________________________________

On average pay (includes Earned


leave under Revised Leave Rules
1993)
On average pay on M.C
On half average pay
On half average pay on M.C
On half average pay on private
affairs
On quarter average pay
On quarter average pay on M.C
Extraordinary Leave

Total

14 Certified that Earned leave on average pay for ______________ months and ________ days
from ____________________ to ___________________ is admissible under article ___________
of the ______________________________ rule.

Dated: Signature

Designation
15* Orders of the sanctioning authority

Dated: 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 a similar allowance.

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