Earned Leave Format

(FORM – 1)

(See Rule 14)

APPLICATION FOR LEAVE OR EXTENSION OF LEAVE

1. Name of applicant : _________________________________________________

2. Post held : ________________________________________________________

3. Department Office & Section : ________________________________________

4. Pay : _________________________

5. Nature and period of leave applied

for and date from which required : _____________________________________

6. Sunday and holidays, if any Proposed

to be prefixed Suffixed to leave : ______________________________________

7. Ground on which leave is applied

for                                               : ______________________________________

8. Date of return from last leave and

nature and period of that leave: ________________________________________

9. I proposed /do not proposed to avail myself

of leave travel concession for the block years

_______ during the ensuing leave  : ____________________________________

10. Address during the leave period : ______________________________________

Signature of Applicant

(with date)

11. Remarks and /or recommendation

of the Controlling office

Signature (with date)

Designation

CERTIFATE REGARDING ADMISSIBLITY OF LEAVE

12. Certified that ______________________________________ (nature of leave) for ________________ period from ___________ to __________________ is admissible under Rule ________________ of the Central Civil Service (Leave) Rules, 1992.

Signature (with date)

Designation