To be sent to Personnel Department,Kolkata

Office, after Sanction

BRIDGE & ROOF CO. (INDIA) LTD.

(A Govt. of India Enterprise)
APPLICATION FORM FOR

(1) LEAVE
(2) LEAVE ENCASHMENT
(3) CANCELLATION / EXTENSION / REDUCTION OF LEAVE
(4) LEAVE / LEAVE ENCASHMENT EARLIER APPROVED

PERSONNEL DETAILS

EMPLOYEE JOB PLACE OF POSTING/

FULL NAME ( IN BLOCK LETTERS ) GRADE
No. ORDER NO. DEPARTMENT

CIVIL DESIGN
101942 ANIRBAN BISWAS E1 -
(KOLKATA OFFICE)

CONTACT E-MAIL FAX NO.

PLACE / ADDRESS WHILST ON LEAVE
NO. * *
Kolkata 8902234022

* If available
APPLIED FOR

(A) LEAVE (B) LEAVE ENCASHMENT

NUMBER OF DAYS TOTAL

FROM TO DAYS NUMBER OF DAYS (P.L.)
P.L. S.L. C.L.
25/7/2017 29/7/2017 5 5

SIGNATURE DATE :03/07/2017

FOR USE BY
SITE INCHARGE / HOD / SANCTIONING AUTHORITY

RECOMMENDATION
N A M E DESIGNATION /SANCTION / SIGNATURE & DATE
REMARKS
DGM (DESIGN)
Mrs. J. RAHA
PROJECTS
Shri. G.K. DATTA GM (DESIGN)
DESPATCHED BY SITE DATE : SIGNATURE

RECEIPT BY PERSONNEL DEPARTMENT DATE : SIGNATURE

ENTRY SL. NO. IN THE LEAVE FILE DATE : SIGNATURE

TING/