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DGM-Electrical (M)

Sub: Application for Privilege Leave

Name :______________________________________________Regn No:__________

Designation: ___________________________________________________________

Department : ______________________________ Section : _____________________

Applied from : __________________________ To :_____________________________

REASON FOR LEAVE:

Leave Address:

Date :__________
(Signature of employee)

Action by HOD: Leave Approved: Leave Not Approved:

PL Approved: From __________________To : ___________________

Leave Without Pay Approved: From __________________To : ___________________

________________________
(HOD)

Designation_________________________

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