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ELFORM

FORM OF APPLICATION FOR LEAVE

 

1.Name of the Applicant                      :

 

 

2.Address during Leave Period            :

 

 

 

3.Post held                                         :

 

 

4.Department, Office and Section       :

 

 

5.Pay                                                 :

 

 

6.H.R.A., Conveyance allowance or

   other compensatory allowances

   drawn in the present post                :

 

 

7.Nature and period of leave applied

   for and date from which required     :

 

 

 

8.Sundays and holidays, if any,

   proposed to be prefixed/suffixed

   to leave                                           :

 

 

9.Ground on which leave is applied for:

 

 

 

a)    I undertake to refund the difference between the leave salary drawn during leave on average pay and that admissible during leave on half average pay which would not have been admissible had to proviso to F.R.81(b)(ii) not been applied in the event of my retirement from service at in the end or during the currency of the leave.

b)    I undertake to refund the leave salary drawn during “leave not due” which would not have been admissible, had F.R.81(c) not been applied, in the event of my voluntary retirement from service at the end or during the currency of the leave.

 

 

 

Signature of Applicant

(with date)

Remarks and/or recommendation of

the Controlling Officer

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