Yogyakarta, 13 Januari 2020.

LEAVE APPLICATION
To : Human Resources Department
Name : Ktut Mahendra Yudi Mahendra
Payroll :
Dept : Accounting
Adress : Trukan Poitan RT 06, Mandungan,
Srimartani, Piyungan, Bantul,
Yogyakarta
Kindly give me permition to be absent from duty due to :

1. Advance Leave ( 12 days ) 6. Birth of child/child circumstance ( 1 day )

2. Long Leave ( 01 days ) 7. Marriage of son/daughter ( 2 days )
3. Sickness ( see note ) 8. Death of wife/child ( 2 days )
4. Pregnancy ( 3 months ) 9. Death of brother/sister ( 1 day )
5. Wedding ( 2 days ) 10.Death of Parent ( 2 days )

Period : 14 Januari 2020 (01) working days

Annual Leave balance : .........

Note : a. Mark the point desired
b. Leave must be applied two weeks before leaving
c. Attach the neccessary documents to this application
d. Sick Leave, dokter certificate must be enclosed
e. Use three copies of this form No. 1 and 2, one copy for the others

Write down the reason for postponement/refusal of annual leave or long leave

Date : Date :
Approved/Refused by Approved/Refused by
DEPARTMENT HEAD SECTION HEAD HR.MANAGER

Note : Effective date of employment : 14 / 08 / 2017

Year period of mentioned annual leave : 2017 / 2018

Requested by :

Ktut Mahendhra Yudi M