LEAVE APPLICATION

Surname First Employee No

Names

I wish to apply for leave Signature: Date:

as follows:

Annual Paid Annual Unpaid

Sick Paid Sick Unpaid

Maternity Normal Pay Maternity Partly Paid

Study Paid Study Unpaid

Incentive

Family Responsibility

Other

From 1st day of Leave To Last day of Leave

Period of Leave

Medical Certificate (If required)

Attached

Not attached
Approved
Name
Head of Department / Manager
/ Supervisor Signature