g wagon oriea venta 2hG 278 APPLICATION FOR LEAVE 9 “SAE 8 az) So wh ses ae A cons Sar sero, et 210, 3 fra ores sree wet Fe aot wa ge A ea fee ay sa Fat aR Feet 8y (b) (i) FHT 2 one raed as tera Sree EB fare arse fea fee oes ae we 12 eae Torey seme a en Hem hen 15 oe 1a Sere sreraiee oecefre at cen ee TB Note: tem +8 must be filed in by ll applicants whether Gazetted of Non Gazetted {tem 10 applies only in the case of applicants subject to the ordinary leave ules under the FR. who apply for leave on average pay on medical certificate or an extension of thet leave une the provision to FR. 81 (0) (i). item 12 applies only in the case of Gazetled Officer. stem 13 and 14 applies inthe case of Non-Gazetted Officer 4, ames: =a 70H Namie of applicant “ 2. WA fascia Me Leave Rules applicable 3. "EPosthela. 4. arniee am PM Department of off. 5. tmPay, . 6. ada we feet aren arta, ward ora aT House allowance, conveyance allowance or olher compensatory allowance drawn in the present post. 7A, et fre cer en, ar were site orale ae we ore Nalure and period of leave appli for and date from which required, 3, 5p! 89 & ar Ground on which leave is applied for 9, faerat gga ed at iter ote va yet am ware he sa Date of return from leave, and the nature and period ofthat leave. 00, sts ee ae et A sea fetter ae cote oe Be stare A am 9 am wes BE HEL ches ‘sae ware ee Se Fagta a car ar Ge 81 (i Be we erm, Fel ane we ONG aT gem Se J undertake to refund the difference between average pay and half average pay for the period of leave on average ay ahich would not have been admissible had the provison to FR. 81{i) not been applied in the event of my fetirement from service al the end or during the currencoy of the leave. fafa Date arden Gea Signature of applicant 11. Prise sft Rema steer sete Remarks and/or recommendation of the Controling Oficer FaMeR Signature e374 Designation raf Date 42, Arar vies safirant 34 feat Report of the Audit Officer . FIR Signature fafa Date ‘eATA Designation19, ge ones aed once at agg a Me et fre Slatement of leave granted to applicant previous to this application. gainer teat a fod ad & m Nalvre of leave in current year, During past year Total refer Casual ‘reer Bf Privilage Leave. sree eee (gah atcha aftehfirs gl Pe 1933 & otha sata WET A SY On average pay (includes Eamed leave under Revised Leave Rules, 1933) ‘Sra TAM atte ET On average pay on M.C.. -sraet acm e-attar fers On hal average pay on M.C. frst aire wg -sfrer 8a On half average pay on private affairs. “eo sta art On quarter average pay . “erect am-rg staé 24W On quarter average'pay on M.C. TOT Bel Extra-ordinary leave, FA Total 44. seo fara fi, _arfranifen % iti, - a. F . feat fer, Certified that Leave on. : average pay for Eamed leave Mortheand Mays OM. 10 : is admissible under articlesirule of the. Fema Signature > fa Date ‘4TH Designation 16 owe wtierd & are: Oyzers ef the Santtioning Authority FEIPR Signature fifa Date “ea Designation Safe crear ae, wftrere rar ara a get ec eae ET RE Hen TES aT Sra IS ger ees aT ET Sar se, dee AC are wand peer Rest Ifthe applicant is drawing pay compensatory aiowance the santioning authosty should state whether on the expiry of leave he is likely to rotuen tothe same post oo another post earrying a similar allowance, (Co. Pes Fanaa Pade 120 ve