INDIAN INSTITUTE OF INFORMATION TECHNOLOGY BHAGALPUR
LEAVE APPLICATION
1. Name of the applicant
2. Designation Emp_No.:
Dept. / Section / Centre
3. Nature & Period of Leave Nature From To No. of Days
(For Spl. CL, Commuted Leave, EL,
Maternity Leave, Paternity Leave etc.
please attach supporting papers)
4. Holidays, Prefix From: To: No. of Days:
Prefixing / Suffixing Suffix From: To: No. of Days:
5. Reasons for leave
6. Whether the applicant proposes to avail of Leave Travel Concession during
the ensuing leave. If yes, please submit the Application for LTC (Form YES NO
No. 11) duly filled in along with this application.
7. Whether Station Leave permission required or not Yes, From: To: NO
8. Are you holding any other position like HOD, HOC, HOS, Warden,
Chairman of a Committee etc. If so, please enclose the approval/
consent of appropriate authority for the period of leave.
*9. Arrangement for classes during the No. of classes Alternative Arrangement:
proposed leave (for faculty members) to be missed:
10. Address while on leave
Contact Phone No. (if any): Pin:
11. In the event of my resignation, voluntary retirement, dismissal or removal from service or in the event of termination of my service,
I undertake to refund:
a) The leave salary drawn for the period of Earned Leave, which would not have been admissible, had that leave not been
credited in advance
b) i) The difference between the leave salary drawn during commuted leave and that admissible during half pay leave.
ii) The leave salary drawn during leave not due.
_______________________
Date : ___________________ Signature of the Applicant
Remarks and/or recommendation of HOD/HOS/HOC/Registrar
____________________________________________
Signature
Designation : _______________________________
Date : __________________ Dept./Section/Centre : ________________________
Note: 1. All kinds of leave, except Casual Leave should be applied in this form and forwarded to Admn./ Faculty Affairs after recommendation of
the concerned HODs/HOSs/HOCs. Casual Leave should be applied in the CL Card maintained in the respective Dept./Section/Centre.
2. In case the leave is requested for Project related work, please mention the Project No. at the top of the application and forward to Dean,
R&D through the concerned HOD/HOC/HOS.
*3. If the proposed leave is during the semester period, please furnish the details of alternate arrangement for the missed classes.
FOR OFFICE USE
Certified that the following leave is admissible to:
Name of the applicant
Designation
Dept. / Section / Centre
Nature and period of leave admissible Nature From To No. of Days
Holidays Prefix
Prefixing / Suffixing
Suffix
Station Leave From : To : No. of Days :
Balance of leave as Vacation Leave Days
on .....................................................
Earned Leave Days
Half Pay Leave Days
Casual Leave Days
Special Casual Leave Days
Leave as above may be approved:
__________________________
Signature of the dealing officials
Approval of Sanctioning Authority:
_______________________________
Signature of the Sanctioning Authority
Please return to HOS (Admn. / Faculty Affairs)
