LEAVE APPLICATION FORM

Name of Employee:_______________________________________________________________________________
Designation: ___________________________________ Department: ___________________________________
Type of Leave:  Annual  Unpaid  Special  Sick  Casual 
Maternity  Military  Medical (Attach required certification) -  Family: 
Parent,  Spouse,  Child  Others, please specify _______________________

Leave Request
Start Date End Date Total Days Resuming Work Days Remarks

Contact Address & Tel No. while on leave_______________________________________________________

_________________________________________________________________________________________________________
Remarks: _____________________________________________________________________________________________

DATE: ________________________ EMPLOYEE SIGNATURE: ________________________

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TO BE FILLED BY ACCOUNTS AND ADMINISTRATION:
Employee Code: ________________________________________ Date of Joining ____________________________
Date last returned from leave____________________________ Leave balance in days: _________________

Leave and fare entitlement: _______________________________________________________________________

Fare payable by  Employee /  Company -  For Self  Self + Family

Loan balances of Employee: Salary Advance_______________________/HRA loan_______________/

Other Advance_________________________

DATE: ________________________ HR & ACCOUNTS DEPARTMENT: _______________________

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Note: Employee must submit leave application from at least 7-14 days prior to leave taken.
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LEAVE :  APPROVED /  NOT APPROVED
Date from _________________________________to____________________________ No of days______________
Comments: _______________________________________________________________________
DATE:______________ APPROVED BY MANAGER____________ DIRECTOR________________