LEAVE APPLICATION FORM

Date: 24 01/20 2
Employee's Name: k.SAmU EL Department: Enqdneey Location/site:

Date
Number of days leave requested for
o3 day's From:01/10l21 T 03/1o/21
If Half day
Morning or Afternoon
Reason for Leave:
Pex Sma

Address During Leave Period k.sAm UEL, HU PPetc),N-G.PADUVoy

Pgakasan (bist) , p} sa3 I&I. ph 4499D 2sSE
Signature of Employee kée
Addl Charge:

Last Leave Taken:

Remarks& Signature of Dept.Head
Date: Recomnded/Not Recomnded

For Admin Department

Number of days entitled

Leave adjusted against the balance

Leavewith out pay (to be adjusted in Payroll)D Signature of Admin Executive

Remarks & Signature by Admin Manager

Date:

Remarks & Approval by Executive Director

Date: