Ticket No.________________________Designation_______________ Where employed__________________ Date of appointment________ Period of leave___________________ Nature of leave_____________ Date from which required ____________________________________ Leave already taken during the year____________________________ Why required______________________________________________ Address while on leave where correspondence should be addressed in case of recall or overstay___________________________________________ Pass application attached. ______________________________________________________ Pass not required Leave admissible as follows
Signature of authority verifying leave Signature of thumb-impression
application leave applicant.
Recommendations: Order of the sanctioning authority.
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