Indian Institute of Science Education and Research Berhampur

Leave Application

Casual Leave Restricted Holiday Special Casual Leave

Earned Leave Half Pay Leave Commuted Leave
Vacation Leave Extra-ordinary Leave Station Leave
Paternity Leave Maternity Leave Others (Specify)

1. Name PF No.
2. Designation Dept.
3. Leave applied for No. of days Date From To

4. Prefixing date (In Suffixing

case of holidays) date
5. Purpose of leave
6. Address during leave of
absence

Mobile No.
7. Charge/ officiating
arrangements made
during leave of absence
(Leave application should be submitted in the Registrar’s Office / DOFA atleast 10 working days in
advance and should proceed only after receiving the sanction order).

Date: Signature of the employee

For office use only

Forwarded & Approved as per rules

recommended by

Section-I/c HOD DR Registrar DOFA Director

Officer-I/c For CL/RH Group ‘B’ and Group ‘A’ Academic DD/Dean(s) /
/HOD/Dean only ‘C’ Staff Staff Staff R/HODs