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LEAVE REQUEST FORM

Date: / / 20 _______

Employee Name: Department:

Reason for requested leave: (please tick appropriate box)

 Annual leave  Maternity leave  Holiday leave  Other


___________________
 Unpaid leave  Parental leave  Compassionate leave

Dates Requested: / / 20_______ to / / 20_______


Total Days: day (s)

Maximum of annual leave per year : 12 Days


Leaves taken : Days
Leaves balance : Days

Manager/Supervisor Approval:  Approved  Rejected

Employee’s signature:

_____________________________

Notes/Comments:

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