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To,

The District Medical & Health Officer


West Khasi Hills District, Nongstoin

(Through the Medical & Health Officer I/c Markasa PHC, West Khasi Hills District )

Subject: Application for Medical Leave

Madam,

With reference to the subject cited above and the medical certificate enclosed, I hereby
request you to kindly grant a medical leave for the duration mentioned in the formatted application
summited herewith.

This is for your necessary action and I would always be grateful for your kind
consideration.

Date: Yours Faithfully

Place:

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