INDIA LIMITED

Staff Leave Form

PLEASE SUBMIT COMPLETED FORMS TO THE PAYROLL OFFICE Name Employee Payroll of DEBASMITA GHOSH

Exempt (Salaried)

SALARIED

Non-Exempt

(Hourly) Leave Dates 09/08/2012 for a total of 9 hours. Start Date 09/08/2012 End Date 09/08/2012 What type of leave is being requested? CL Vacation YES Sick (Please attach appropriate documentation to this form.) Relationship of the deceased to the employee: ________________________________ Jury Duty (Please attach appropriate documentation to this form.) Unpaid Leave (please explain on line, below) Other (please explain on line, below) Due to my birthday I want to take leave on 09/08/2012.

Debasmita Ghosh Employee Time

Signature

06/08/2012 Date &

Department: I.T

Approval Date:

NOTE: All leave must be taken in accordance with IL policy as stated in the Employee Rules and Regulations. It is the responsibility of the employee to request vacation leave in advance of the dates requested. It is the responsibility of the Management to ensure the approved leave form is submitted to the Payroll Authority for recording.