SOUTHERN RAILWAY

APPLICATION FOR GRANT OF LEAVE TO BE AVAILED OUTSIDE INDIA

(TO BE SUBMITTED IN DUPLICATE)

1.

Name of the employee

2.
3.

Designation & office

at which working
Pay & scale of pay

4.

Date of birth

5.

Date of appointment

6.

Date of confirmation

7.

Date from which leave

required to be availed out of
India
Nature of leave applied for

8.
9.

Reason for applying for leave

to be availed out of India

10.

Passport number

11.

Details of private foreign travel to be undertaken for which permission is

required now:

Period of stay
abroad
From

12.

To

Purpose of
Visit

Estimated
expenditure

Source of
fund

Remarks

(Travel, boarding,
lodging, visa etc.,)

Details of previous foreign travel if any, undertaken during the last four years.

Period of stay
abroad
From

Name of
foreign
countries to
be visited

To

Name of
foreign
countries to
be visited

Purpose of
Visit

Estimated
expenditure
(Travel, boarding,
lodging, visa etc.,)

Signature & designation of

the immediate supervisor.

Source of
fund

Remarks

Signature of the employee

Designation
(for office use only)

No.V/P.

Divisional Office
Personnel Branch,
Trivandrum -14.
Dt.

Forwarded to CPO/MAS for necessary action.

Divisional Personnel Officer

For Disposal and Sanction with the following details

1.

No. of leave recommended

(give particulars of
LAP/LHAP at credit)

2.

Whether he/she is in
occupation of quarters

3.

Whether the employee has

given in writing that he/she
would not extend the leave
and will not engage
himself/herself in any
employment outside India

4.

Whether he/she is solvent or

habitual indebted

5.

Whether he/she is free from

DAR/SPE/VIG cases

6.

Whether he/she is
undergoing any penalty
under DAR

7.

Whether the employee is

due to Railway by way of
loans and advances taken
by him/her and whether any
safe guard has been taken
for recoveries of the dues

8.

Recommendations of the
controlling officer for
sanction of leave outside
India

Station:
Date:

Signature of the controlling officer

Designation:
(with office seal)