AMRITA

INSTITUTE OF MEDICAL SCIENCES

A CENTRE OF AMRITA VISHWA VIDYAPEETHAM

LEAVE APPLICATION FORM

Date: / /

Employee Name: Employee Code:

Designation:

Number of Days: Date: from: to:

Type of Leave: CL / SL / PTO:

Half day Morning OR Afternoon

Reason for leave:

Charge to be handed over to during leave (name of person and

designation/employee code)

Contact No. during leave other than own mobile no.

Signature of Employee
Leave Balance Opening
(For HR and Finance)
Adjusted now

Balance Leave as on date

Leave without pay (to be adjusted in payroll):

Approved by Dept. Head Final authority Endorsed by H.R Department

Name and Signature Name and Signature Name and Signature

Date: Date Date