LEAVE REQUEST AND APPROVAL FORM Date:………………..……

To

: ……………………………………………. (Respective Supervisor)

From

: ……………………………………………

Designation

: ………………………………………….…

Division/Section: …………………………………………..

Kindly grant me leave as follows: Sl. No.

Type of Leave

Select to Avail (√)

Duration Start Date

End Date

Remarks Total No. of Day(s)

1

Casual Leave

*

2

Earned Leave

3

Maternity Leave

* Endorsement of Head of Dept. Attach Evidence

4

Paternity Leave

Attach Evidence

5

Medical Leave

Attach Evidence

6

Extraordinary Leave

Execute Legal Undertaking

7

Bereavement Leave

* Submit Reasons: ………………………………………………………………………

Date and Signature of Applicant

Remarks/Recommendation of Supervisor/Controlling Officer

Leave Form.pdf

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