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Leave Application Report

The document is a leave application submitted by Dipti Bhattacharjee, a Health Assistant, requesting 15 days of commuted leave from November 21, 2020 to December 5, 2020 for medical treatment, as well as suffix leave on December 6, 2020. She is currently drawing a monthly salary of Rs. 7,272 and will be traveling outside of station during her leave. She has submitted a medical certificate and undertakes to refund any salary overpayment if she resigns or retires.

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Shubhrajit Maitra
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342 views1 page

Leave Application Report

The document is a leave application submitted by Dipti Bhattacharjee, a Health Assistant, requesting 15 days of commuted leave from November 21, 2020 to December 5, 2020 for medical treatment, as well as suffix leave on December 6, 2020. She is currently drawing a monthly salary of Rs. 7,272 and will be traveling outside of station during her leave. She has submitted a medical certificate and undertakes to refund any salary overpayment if she resigns or retires.

Uploaded by

Shubhrajit Maitra
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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APPLICATION FOR LEAVE

1.Name of applicant: DIPTI BHATTACHARJEE Leave application no:202011102786745


2. HRMS ID: 1985002608
3. Post Held: Health Assistant (Female)
4.Leave Department: Leave Other
5.Parent Department: Health & Family Welfare
6.Present Department: Health & Family Welfare
7.Employment Type: Permanent
8.Employee Type: Employed
9.Leave Rules applicable: Rule 173 (3) of WBSR-I
10. House allowances, conveyance 7272 0 0
allowance, or other Compensatory
allowances drawn in the present post:

11. Nature and period of leave applied for 1.Name of leave:Commuted Leave
and date from which required: 2.Period of leave from:21/11/2020 to 05/12/2020
3.Prefix from:NA to:NA
4.Suffix from:06/12/2020 to:06/12/2020

12.Purpose of leave: Medical ground

13.Ground on which leave is applied for: For treatment on medical ground.

14.Documents submitted (if any): Medical Certificate

15.Date of return from last leave, and the 29/10/2020,Commuted Leave,05/10/2020 To 28/10/2020
nature and Period of that leave:

16.Are you leaving station: Yes


17.If yes, then period of station leave: From:21/11/2020 To:06/12/2020
18.Address for communication during Satwick (2nd Floor),
station leave: 4/30, Govt. Colony,
New Rathtala, Belgharia,
Kolkata - 700056
19.Contact no. during station leave: 9046938049

20.Declaration/undertaking (if any): I undertake to refund the difference between the leave salary drawn during
Commuted Leave and leave salary admissible during HPL In the event of my
resignation/retirement etc. from service.
Dated Signature of Applicant

21.Remarks and/ or recommendation of


the Controlling officer:-

Dated Signature
BMOH KALIYAGANJ

Dated Signature

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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