S.
R 1
APPLICATION FOR LEAVE
FORM OF
(rTYT fruu 216 dfad) (See Supplementary Rule 216)
whether gazetted or non-gazetted.
to 11 must be filled in by all applicant
Note ems 1
1. Tet 7 74/ Name of Applicant . .
2. ************************
Leave rules applicable .
Post held . . *****'******* ***
Department, Office and Section..
5. /Pay
5.
allowance or
conveyance
House rent allowance,
allowances drawn in the
other compensatory
present post.
7.
arTENature and period of leave applied for
and date from which required.
8.
If proposed to be
Sundays and holidays. any
prefixed/suffixed to leave.
9.
Ground on which leave is applied for
fer aT 37af1
Date of return from last leave, and
the nature
and period of that leave
11. H faar APTE . * * * * * * * * * * * * * * * e * * * * * * * * *
concession in the block years
T61 Ppropose / do not propose to avail myself of leave travel
*********************************'*'****
.. *. during the Ensuing leave.
() (ii) a7 7 EH TR 3774 7 at
1933 fqu 11
I undertake to refund the difference
between the leave salary drawn during leave on averagge
(a)
leave on half average pay/ half pay leave,
pay/commuted leave and that admissible during
to F.R. 81 (ii) rule ll (c) (ii) of the
which would not have been admissible had the proviso
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.
81 (7) Hivifia E t fAqHTat 1933 f 11 ( ) EN] 7 fsy AT Y fra vit,
(b)I undertake to refund the leave salary drawn during leave not due which would not have beon
admissible had F.R. 81. (c) Rule l (d) of the of the Revised Leave Rules 1933 not been
applied, in the event of my voluntary retirement or resignation from service at any time until
I earn half pay leave not less than the amount of leave not due availed of by me.
Date
Signature of applicarnt '''**'''**'
13. fum 3fiTt Tt fzuuit 3itvm frsften
Remarks and/ or recommendation of the
controlling Officer,
E Signature '*"***** '***** *****'*****'****i
THTDesignation ****** ** **" ** *****
Date * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
CERTIFICATE REGARDING ADMISSIBILTY OF LEAVE
(By Accountant General in the case of gazetted officers)
* ****"***
14. 4TTura f41 T f
****************'** *** ******'***** * ***"*******************"*"
(E f ) ATH
* * *'******
*************************'"
Certified that ... (Nature of Leave)
for OTl......
. ***"*******************
(Period)
is admissible under rule ... of the ******* *******'** ********* Rules
R R Signature * ***************
Date * ****************** ************'*****': TRHT4 Designation ******
15. yfa ar ATT ATRI
Orders of the sanctioning authority
FET&/Signature ***********
Da * i **************************** YKATH Designation. ***************
i f 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
TARANG PRESS, PATNA, March 2009, 100000
