Ministry of Health & Indigenous Medicine Eastern Province

Application for Off Pay & Holiday pay (To be submitted duplicate monthly)
Month/Year..
Part-1 Claim by Officer
1. Name of M.O:-
2. Designation:-..
3. Institution:-.
4. Detail of work (Duties with units):-.
5. Reason of attending this work on holiday & off day:-.
6. Reason to not attending to this during normal hours:-..
7. Rate of off pay & PH:-..
8. No of off pay & PH required:
(Please mention the day work with time spent)
a :..
b
c
9

Total payment expected & Particulars:-...

I declare that the above are true & due to the reasons mentioned at 1:5 &1:6 this claim is made.

Date:-..

Signature

Part-11 Comments by the Head of branch

Reason for attending this on off pay / PH
Any other comments in recommending this application
No of days recommended for the month of ..is off pay & PH pay
Onis recommended.

Date:-..

Signature of Head of Branch

and Designation.

Part 1v Availability of Funds.

Funds not available/Available.
Balance on.isunder
Vote
Date:-.

Chief Accountant/Accountant

Part-V
Holiday and off pay on .. (Para 1:8) is approved.

Date:-

.
Deputy Provincial Director
Of Health Service.