Leave Request Form

Employee Details
Employee Name Position Employee Number Department

Leave Details
Last day at work: Annual Leave Business Trip
Return to work: Unpaid Leave Sick Leave
Death Leave Emergency Leave
Number of leave days : day’s Others, Specify

Employee Leave Requirements:

Visa Required Yes No Destination: /
no.:
Ticket Required .: Yes No Exit / Re-Entry Visa Required :

Class: # no of days:

Daily Allowance:

Advance Allowance Amount Amount:

HR Department Use Employee’s Dependents Leave Requirements

Entitlement:
Exit Re-entry Ticket Name
Taken During the Year:

Balance Available:

Requested:

Balance After Request:

GM Yes No

Requested By:
Employee Signature:
Name :

Approvals:
Site In Charge Yes No

HR Yes No

PM Yes No

GM Yes No

DOC #: MIA-HR-FRM07
V0, 1-Dec-2016 1