Company Name:

LEAVE APPLICATION FORM

NAME: Date:

Designation: Department:

CONTACT ADDRESS WHILE ON LEAVE: TEL NO: ____________________

Purpose: ______________________________________
_____________________________________________
_____________________________________________
From To Total no. of
Leave Type days Remarks
( dd/ mm/ yy ( dd/ mm/ yy )
Sick Leave )
Casual Leave
Priviledge Leave
Leave without Pay
Compassionate Leave
Other Leaves please specify :

Re-joining Date
Name & Signature of applicant : / /

Name & signature of HOD :

Leave Sanctioned / Not Sanctioned________________ days

Sick Leave _______________ days

Casual Leave _____________ days

Emergency Leave _________ days

Leave without Pay _________ days

Compassionate Leave ______ days

HR Signature

Note:-
1. Casual Leave will not normally granted if application is not submitted 48 hours in advance,except medical leave
2. Application for annual leave should be sumitted 30 days before leave commences.
3. Other than Priviledge leaves,please attach relevent supporting documents for reference.
4. Failure of applicant to resume duty after the leave period will be deemed negligence of duty and may be subject to summary
dismissal by the company

Mr/ Mrs/Ms: ___________________________________________________________________________

Your Application for _____________________________________________________________________
Has been sanctioned/ not sanctioned ___________________________________________ Leave
From Date:______________________ To ____________________

Date: ______________________ _______________________

HR Manager