Leave Application Form Serial No:

Date:

Name:

Position

Department

Work Entry Date

Reason for Leave

Monthly Leave

Casual Leave Total

Type of Leaves Number of
Sick Leave Leaves

Annual Leave
Number of
Leave from Leave to Back to Work
leave Days
Leaves Detail

Requested By Applicant: Approved By Administrative: Head of Department

(Name/Signature) (Name/Signature) (Name/Signature)