LEAVE FORM

DOB DOJ DO Dept DO Arrival

FORM OF APPLICATION FOR LEAVE
(See Supplementary Rule 216)
Note: - Items 1 to 11 must be filled in by all applicants whether gazetted or non-gazetted
1. Name of applicant
CCS (leave) rules 1972
2. Leave rules applicable
3. Post held
IA&AD, O/o the Pr. AG (Audit) Punjab, Chd.
4. Department, Office and Section
Rs.
5. Pay
6. Conveyance allowance or other compensatory
allowance drawn in the present post.
EL/Comm. Leave.
7. Nature and period of leave applied for and date
from which required.
8. Saturday/Sunday and holidays, if any,
proposed to be prefixed/suffixed.
9. Ground on which leave is applied for
10. Date of return from last leave and the nature
and period of that leave.
11. I Propose/do not propose to avail myself of
leave Travel Concession (LTC) in the block
year’s………….during the ensuing leave.
12. (a) I undertake to refund the difference between the leave salary drawn during the leave on average pay/commuted leave
and that admissible during leave on half average pay/half pay leave, which would not have been admissible had the
provision to FR.81 (b)(ii) rule 11(c)(iii) of the Revised Leave Rules, 1933 not been applied in the event of my retirement
from service at the end or during the currency of the leave.
12 (b) I undertake to refund the leave salary drawn during the leave not due, which would not have been admissible had the
. provision to FR.81 (c) rule 11(d) of the Revised Leave Rules, 1933 not been applied, in the event of my voluntary
retirement or resignation from service at any time until I earn half pay leave not less than the amount of leave not due
availed of by me.
13. Leave Address during leave period

Date………….. Signature of applicant and Designation

Remarks and/or recommendations of the controlling Officer.
14.

Signature of Sanctioning Authority

CERTIFICATE REGARDING ADMISSIBILITY OF LEAVE
(By Pr. Accountant General in the case of Gazetted Officers)
Certified that. ……………(Nature of leave) for ……… from…………… .to ……………. . is
15.
admissible under rule …………of the CCS (Leave) Rules 1972.

Date………….. Signature and Designation

16. *Orders of the sanctioning authority: -

Date………….. Signature and Designation

*If the applicant is drawing any compensatory allowance, the sanctioning authority should state whether on the expiry of leave
he/she is likely to return to the same post or to another post carrying a similar allowance.
No. Dated:
 LEAVE FORM
DOB 01.01.1977 DOJ 25.05.2000 DO Dept 02.10.2021 DO Arrival
FORM OF APPLICATION FOR LEAVE
(See Supplementary Rule 216)
Note: - Items 1 to 11 must be filled in by all applicants whether gazetted or non-gazetted
SATISH KUMAR
17. Name of applicant
CCS (leave) rules 1972
18. Leave rules applicable
ASSTT. AUDIT OFFICER
19. Post held
IA&AD, O/o the Pr. AG (Audit) Punjab, Chd.
20. Department, Office and Section
Rs.73400/- (LEVEL-9)
21. Pay
NA
22. Conveyance allowance or other compensatory
allowance drawn in the present post.
Thirteen days Earned Leave from 02.10.2021 to
23. Nature and period of leave applied for and date
14.10.2021
from which required.
Prefixed
24. Saturday/Sunday and holidays, if any,
Suffixed
proposed to be prefixed/suffixed.
Due to jaundice and lack of plaitless in blood
25. Ground on which leave is applied for
NA
26. Date of return from last leave and the nature
and period of that leave.
27. I Propose/do not propose to avail myself of
leave Travel Concession (LTC) in the block
year’s………….during the ensuing leave.
28. (a) I undertake to refund the difference between the leave salary drawn during the leave on average pay/commuted leave
and that admissible during leave on half average pay/half pay leave, which would not have been admissible had the
provision to FR.81 (b)(ii) rule 11(c)(iii) of the Revised Leave Rules, 1933 not been applied in the event of my retirement
from service at the end or during the currency of the leave.
12 (b) I undertake to refund the leave salary drawn during the leave not due, which would not have been admissible had the
. provision to FR.81 (c) rule 11(d) of the Revised Leave Rules, 1933 not been applied, in the event of my voluntary
retirement or resignation from service at any time until I earn half pay leave not less than the amount of leave not due
availed of by me.
29. Leave Address during leave
#- 1317-A
Sector-41-B, Chandighar
(AAO)
Date 05.10.2021 Signature of applicant and Designation
Remarks and/or recommendations of the controlling Officer.
30.
Signature of Sanctioning Authority
CERTIFICATE REGARDING ADMISSIBILITY OF LEAVE
(By Pr. Accountant General in the case of Gazetted Officers)
Certified that. ……………(Nature of leave) for ……… from…………… .to ……………. . is
31.
admissible under rule …………of the CCS (Leave) Rules 1972.

Date………….. Signature and Designation

32. *Orders of the sanctioning authority: -

Date………….. Signature and Designation

*If the applicant is drawing any compensatory allowance, the sanctioning authority should state whether on the expiry of leave
he/she is likely to return to the same post or to another post carrying a similar allowance.
No. Dated: