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LEAVE APPLICATION FORM

Full Name & Surname M. FARIZKI

Division / Department SURVEYOR

SECTION A: TYPE OF LEAVE


Type of Leave Number
Duration – all dates included Contact Details while on Leave
(Please tick the appropriate) of days
√ Annual Leave 30 Oktober 2018 1 Day Address: Belakang Padang
 Sick Leave (valid Doctor’s Certificate required) to
 Maternity Leave to
 Family Responsibility Leave to Tel: 085835623478
 Unpaid Leave to E-mail: mfarizki10@gmail.com
Reason of Leave : Acara Keluarga

27 Oktober 2018
Requested by: Employee’s Signature Date

SECTION B: APPROVAL REQUIRED PRIOR TO ABSENCE ON LEAVE

Signature Signature

Print Name Date Print Name Date

APPLICATION FOR LEAVE RECOMMENDED: YES/N O * ) APPLICATION FOR LEAVE: APPROVED/NOT APPROVED*)
by MANAGER by SUPERVISOR

Notes : *) Please circle the appropriate

SECTION C: ADMINISTRATION Checked by,

Leave Available:
Leave Granted:
Balance:
Office Administrator

EP-FM-ADM-10 Rev 00

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