FORM – 1

(See Rule 14)

APPLICATION FOR LEAVE / EXTENSION OF LEAVE (FOR REGULAR

OFFICERS/STAFF)

1. Name of Applicant

2. Present Post

3. Department, Office and Section

4. Present Pay

5. House Rent and other Compensatory

Allowance drawn in the present post

6. Nature and period of leave applied

for and date from which required

7. Grounds on which
leave is applied

8. Sunday and holidays, if any,

proposed to be Prefixed /
Suffixed to leave

9. Date of return from last leave and

period of leave availed earlier

10. I propose / do not propose

to avail myself of Leave Travel Concession
for the Block years during the leave period.

11. Address during the leave period

Signature of the Applicant

(with date)

12. Remarks and Recommendation of Controlling Officer

Signature (with date)

Designation

13. Orders of the Competent Authority to grant Leave

Signature (with date)

Designation