ADAMJEE INSURANCE COMPANY LIMITED

(Leave Application Form)

Name: Cadre:

Staff No.: Department:

Dear Sir,

Please Grant me leave as under:-

Casual Medical Earned Leave for ________ Days from ___________ to ____________

Recreation Allowance / Leave Encashment _____________________________________________________

Reason for Leave _________________________________________________________________________

Address for while on Earned Leave ___________________________________________________________

________________________________________________________________________________________

Recommended / Disallowed Yours Faithfully

________________________ ___________________
Department Head’s Signature Signature of Application

Casual Medical Earned Leave Balance _____________ days.

To,

Mr. ___________________________________ Staff No. ________________Cadre ____________________

With reference to your leave application dated _____________ Casual / Medical / Earned Leave

Granted / Disallowed for ________ days from __________ to __________ with / without pay / with recreation

allowance / Leave Encashment.

Dated: ________________________ Assistant Manager