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LEAVE APPLICATION FORM

1. PERSONAL DETAILS
SURNAME: DESIGNATION: DEPARTMENT: INITIALS: TEL NO: BU NO: UNIQUE NO.: DATE APPOINTED: SHIFT WORKER: No

Intervening weekends to be counted as leave (except TOIL) Public Holidays to be excluded

2. DETAILS OF LEAVE REQUIRED


LEAVE CATEGORIES
ANNUAL LEAVE OCCASIONAL/ SERVICE LEAVE SICK LEAVE ACCIDENT LEAVE STUDY / EXAMINATION LEAVE CONTINGENCY LEAVE UNPAID LEAVE NATIONAL SERVICE LEAVE MATERNITY LEAVE ADOPTION LEAVE TRADE UNION LEAVE SPECIAL LEAVE TIME OFF IN LIEU OF OVERTIME : Days Hours PAY IN LIEU OF LEAVE PAYMENT OF SALARY IN ADVANCE (Indicate number of days) Date: Cheque:

FROM

TO

DAYS

REF: ESKOM COS


Section 5.1 Section 5.2 Section 5.3 Section 5.4 Section 5.5 Section 5.6 Section 5.7 Section 5.11 Section 5.12 Section 5.13 Section 5.14 Section 5.15 Section 3.8.9 If not full day - indicate amount of hours Section 5.2.3 Bank:

REMARKS
Compulsory - 21 days Accumalative Medical Certificate in excess of 3 days Occupational / Non- Occupational Attach proof - roster / results Indicate reason / relation Indicate reason Attach agreement form Attach agreement form Attach agreement form Approval by IR Manager / Advisor

Minimum of 7 days Minimum leave period 12 days

3. ADDITIONAL DETAILS

4. I HEREBY APPLY FOR LEAVE AS INDICATED ABOVE


Applicant's signature:

5. LEAVE APPROVED (Manager / Supervisor)


Surname & Initials: Designation / Grade: Signature:

(As per delegated signing authority)


Unique no: Date:

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