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LAWRENCE ROAD OFFICE

DEPARTMENT: ________________________
LEAVE APPLICATION FORM
Name of Applicant
Designation

________________________________________________
________________________________________________

Nature of leave requested

Period

From

To

Purpose of leave (Mandatory) ___________________________________ (Need to mention actual reason)


Address while on leave
___________________________________________________________
Contact # while on leave
___________________________________________________________
Applied in VIS:

Yes
No

If No, why ________________________________________________

Application Submission Date:

Leave Status:

________________________________________________
Applicants Signature
To be filled in by Concerned Incharge

Accepted
Rejected

Reason: ____________________________________________
____________________________________________

Date:

Signature
To be filled in by Head of Section

Comments (if any)___________________________________________________________________


___________________________________________________________________
Date:
Signature
To be filled in by Admin Department
LEAVE RECORD
Nature of leave

Entitlement

Leave
Availed

Leave
in Balance

Casual Leave
Earned Leave
Leave without Pay:

Date:

_____________

Entered in Attendance Register:

_____________

Signature of Admin Officer

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