FORM F11 Leave Application Form Employee Name:____________________ Designation:___________________ ____ Corporate/Concept/Territory:_______________ REQUEST FOR: ( Please check the

box of the desired leave ) Annual Leave Sick / Medical Leave Others Leave Requested : Pl.specify From ___________ To_____________ Total Days ___________ Employee No :_________________ Date of Joining: ________________ Date of Application_____________ Maternity Leave Paternity Leave

CONTACT ADDRESS WHILE ON LEAVE

DETAILS OF TRAVEL, if applicable Location Date Of Travel Tickets Self /Co

Employee Name:

Authorized by: Signature & Date

Approved By: Signature & Date

For Office Use Only Details of Previous Leave : From ____________ To _____________ Number of Days for Leave Calculation Number of Days Loss of Pay No. of Days of Service Total Days __________

Leave Balance Available Leave Accrued Leave Availed Leave Available

Group HR Dept

Jan 2005