Leave/Absence Request

Name :

Department :

Please approve the following request for:

 Day(s) of leave From: To:

 Hour(s) of leave Date: From : To :

 Justification Date: From : To :

Type of Leave/Absence

 Annual Leave  Sick Leave  Work Mission  Other

(Specify in Remarks) (Specify in Remarks) (Specify in Remarks)

Remarks:

Employee’s Signature : Date :

Approvals
Direct Manager Head of Department/Management

Signature: Signature:

Date : Date :