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Chandra Hospital

Managed by Bhagat Hospital


RZ-F1/1, MAHAVIR ENCALVE, NEW DELHI - 110 045.

LEAVE APPLICATION FORM

DATE ………………………………………………………………………………………………

EMPLOYEE NAME ………………………………………………………………………………

DEPARTMENT ………………………………………DESIGNATION………………………..

LEAVE REQUESTED FROM………………………………TO………………………………..

REASON FOR LEAVE …………………………………………………………………………..

ADDRESS / TEL NO. WHILE ON LEAVE …………………………………………………….

EMPLOYEE’S SIGNATURE ……………………………………………………………………

RECOMMENDATION ………………………………………………………………………….

IMMEDIATE SUPERVISOR: APPROVED / DISAPPROVED ………………………………

MANAGER: APPROVED / DISAPPROVED…

DISAPPROVED LEAVES REQUIRE SUBSTANTIATION…………………………………

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(SIGNATURE OF THE SANCTIONING AUTHORITY)

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