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IMC Ethiopia Office

Lcave Requcst Form


Employee Name

Title

Site

I hereby request: _ Day(s) ofannual leave Dates:

Day(s) of sick leave Dates:


Day (s) of matemity leave Dates:

Day(s) of Leave without pay Dates:

Days(s) of Mourning leave Dates:

Day(s) of Paternity leave Dates:

_Day(s)R&RLeave Dates:

Others Dates:
If 'Other' specifu
I will leave on
l,ocation [)utc
And return to on
l,ocation I)ate
I will be available for duty again on

ln case ofemergency. please contact me at:

To be lilled bv IIR
Balance ofaccrucd leave available

Requested leave per above

Remaining leave carried for*urd

Leave Approvcd by
Lcal'e Rcqucstcd b.'-
I luman Rcsourcc Supervisor
Name

S ignature

Date

Ilenrark: this leave form is said to be approved when signed by HR Team & Supervisor.

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