APPLICATION FOR LEAVE
Note: - Item No. 1 to 9 must be filled in by all the applicants.
Item No. 12 applies in the case of Government servants
of Grade-16 and above.
1. Name of applicant______Naveeda Amir_________________________________________________
2. Leave rules applicable_______________________________________________________________
3. Post held____________Incharge Head/SST (Arts)____________________________________________
4. Department or office_______GGHS BUTRANWALI_________________________________________
5. Pay___________________________________________________________________________________
6. House Rent Allowance, conveyance Allowance or other Compensatory
Allowance drawn in the present post_______________________________________________________
7. (a) Nature of leave applied for_________EARNED LEAVE___________________________________
(b) Period of leave in days_________30 DAYS_______________________________________________
(c) Date of commencement_______02-10-2024 TO 31-10-2024__________________________________
8. Particulars of Rules/Rules under which leave is admissible____________________________________
9. (a) Date of return from last leave__________________________________________________________
(b) Nature of leave______________________________________________________________________
(c) Period of leave in days________________________________________________________________
Dated____________________ Signature of applicant___________________________________________
10. Remarks and recommendation of the controlling officer______________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
11. Certified that leave applied for is admissible under rule___________and necessary conditions are
fulfilled.
Signature_____________________________________________
Dated_______________________________Designation___________________________________________
12. Report of Audit officer__________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Signature_____________________________________________
Dated_______________________________Designation___________________________________________
13. Order of the sanctioning authority certifying that on the expiry of leave the applicant is likely to
Return to the same post or another post carrying the compensatory allowance being drawn by him.
Signature_____________________________________________
Dated_______________________________Designation___________________________________________
