ASSAM SCHEDULE III (SEC) FORM NO.

71
APPLICANT FORM FOR LEAVE OF NON-GAZATTED OFFICER
To
The Director of Tourism
Station Road Guwahati-1 ,Assam
(Through the Tourist Information officer,Sivasagar.
1.Name of the Applicant

2. Leave rules Applicable

Mehjubin Begum
:

3 .Post held
Officer,Sivasagar

4.Department office
5.Permanant or Temporary

Asstt Tourist Information

Tourist Information Office ,Sivasagar.

6. Pay and Allowances

Pay- 10090.00

7 . House rent allowances/conveyance allow or

Other compensatory or present post
8 .Nature and period of leave applied
for and date from which required
from(1/1/2014
9 .Ground on which leave applied for
10.Date of return from last leave and
the nature and period of the leave
11.Leave account

12%
:

domestic ground for 30 days

31/1/14
:

Domestic ground
:
:

I undertake to refund the difference the leave salary drawn during leave on average
pay/commuted leave and that admissible during leave on held pay/half pay leave which
would not have been admissible had the provision to F.R.81(b)(III)rule13(c) my retirement
from service at the end of during the current of leave.
Date...............

Signature of the applicant

12. Remarks and recommended of the

Controlling officer
13.Report of the Audit officer
Date......................

Signature of Designation