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AR/QP04/02

Biomedical Services

Annual Leave Request Form

Project/Site:

Date of Request

Name

Position
From: / /
Dates of Leave Requested
To : / /
Departure Date from Work

Return to Work Date / Time

Total Number of Leave Days

Number of Leave Days Left

Any Clash Yes No


If yes, the following arrangement is done.

Signature of the Employee ……………………………………….

Authorized by……………………………
Signature………………………..

Administration Use only No. of days ……………… Hours


…………………..

Leave accrued…………….. Leave


utilized…………
Approved ………………………..