25/43/2007. 50,000. G.P.

S © Government of Kerala

Form no. 13

APPLICATION FOR LEAVE

(See Rule 113, Part I)

Note:- Item 1 to 14 must be filled in by all applications whether Gazetted or Non-Gazetted.

1. Name of the applicant : NIDHI.S

2. Date of Birth
3. Post held
4. Department, office and section
5. Pay and Scale of pay
6. Date of entry in service
7. Date of commencement of
Continuous service
8. Address during leave
9. House rent allowance, conveyance
allowance or other compensatory
allowance drawn in the present
post
10. Nature and period of leave applied
for and the date from which
the same is required
11. Holidays, if any, proposed to be
Prefixed/suffixed to the said leave
12. Purpose for which leave is
applied for
13.Date of return from last leave
and nature and period of that leave
: 15/02/1981
: Deputy Director
: Irrigation Dept. O/o The Chief
Engineer (I&D), IDRB, Vikas Bhavan, Trivandrum
: 85000 , 59300 - 120900
: 04/10/2006
: 04/10/2006
:
: HRA- 8500/-, Spl Allowance -550/-
: Earned leave for 20 days from 12/12/2022 to
: 31/12/2022
Prefix holiday on 10.12.22 and 11.12.2022 and
: suffix holiday on 1.01.23 and 02.01.2023.
: Personal health issue.
:

I undertake to refund the leave salary drawn during ‘leave not due’ which would not have been
admissible had rule 85, Part I Kerala Service Rules 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 account of leave not due availed of by me.

Signature of applicant
Place:- Thiruvananthapuram with date
(P.T.O)
 Form no. 13

APPLICATION FOR LEAVE

(See Rule 113, Part I)

Note:- Item 1 to 14 must be filled in by all applications whether Gazetted or Non-Gazetted.

1. Name of the applicant : LEKHA.B.S

2. Date of Birth : 17/10/1977
3. Post held : Deputy Director
4. Department, office and section : Irrigation Dept. O/o The Chief
Engineer(I&D), IDRB, Vikas Bhavan, Trivandrum
5. Pay and Scale of pay : 56700 , 42500 - 87000
6. Date of entry in service : 05/10/2006
7. Date of commencement of
continuous service : 05/10/2006
8. Address during leave :
9. House rent allowance, conveyance
allowance or other compensatory
allowance drawn in the present
post : HRA 2500/- CCA 500
10. Nature and period of leave applied
for and the date from which : Surrender of earned leave for 30 days
the same is required : as on / /2020
11. Holidays, if any, proposed to be
Prefixed/suffixed to the said leave :
12. Purpose for which leave is
applied for :
13.Date of return from last leave
and nature and period of that leave :

I undertake to refund the leave salary drawn during ‘leave not due’ which would not have been
admissible had rule 85, Part I Kerala Service Rules 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 account of leave not due availed of by me.

Signature of applicant
Place:- Thiruvananthapuram (with date)
(P.T.O)
 APPLICATION FOR LEAVE
(See Rule 113, Part I)

Note:- Item 1 to 14 must be filled in by all applications whether Gazetted or Non-Gazetted.

1. Name of the applicant : HARIRAM.N

2. Date of Birth : 28/03/1980
3. Post held : Assistant Technical Examiner.
4. Department, office and section : Finance Dept. O/o The Chief Technical Examiner,
Pulimoodu Junction, Trivandrum
5. Pay and Scale of pay : 56700 , 42500 - 87000
6. Date of entry in service : 28/09/2006
7. Date of commencement of
continuous service : 28/09/2006
8. Address during leave :
9. House rent allowance, conveyance
allowance or other compensatory
allowance drawn in the present
post : HRA 2500/- CCA 500
10. Nature and period of leave applied
for and the date from which : Surrender of earned leave for 30 days
the same is required : as on / /2020
11. Holidays, if any, proposed to be
Prefixed/suffixed to the said leave :
12. Purpose for which leave is
applied for :
13.Date of return from last leave
and nature and period of that leave :

I undertake to refund the leave salary drawn during ‘leave not due’ which would not have been
admissible had rule 85, Part I Kerala Service Rules 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 account of leave not due availed of by me.

Signature of applicant
Place:- Thiruvananthapuram (with date)
(P.T.O)
 2

15. Remarks or recommendations of Controlling Officer:

Signature (with date)

Designation

Certificate regarding admissibility of leave

(By Accountant General (A & E) in the case of Gazetted Officers)

16. “Certified that ………………………………………………………......................

(nature of leave ) for ………………………………………..from …………………
to …………………………………is admissible under rule …………………………
of Kerala Service Rules.”

Signature (with date)

Designation
17. * Orders of the sanctioning authority :

Signature (with date)

Designation

* If the applicant is drawing any compensatory allowance, the sanctioning authority should state
whether on the expiry of leave he is likely to return to the same post or to another post carrying a
similar allowance.
 Form no. 13

APPLICATION FOR LEAVE

(See Rule 113, Part I)

Note:- Item 1 to 14 must be filled in by all applications whether Gazetted or Non-Gazetted.

13. Name of the applicant :

14. Date of Birth :
15. Post held :
16. Department, office and section :

17. Pay and Scale of pay :

18. Date of entry in service :
19. Date of commencement of
continuous service :
20. Address during leave :
21. House rent allowance, conveyance
allowance or other compensatory
allowance drawn in the present
post :
22. Nature and period of leave applied
for and the date from which :
the same is required :
23. Holidays, if any, proposed to be
Prefixed/suffixed to the said leave :
24. Purpose for which leave is
applied for :
25. Date of return from last leave
and nature and period of that leave :

26. I undertake to refund the leave salary drawn during ‘leave not due’ which would not have
been admissible had rule 85, Part I Kerala Service Rules 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 account of leave not due availed of by me.

Signature of applicant
Place:- (with date)
 (P.T.O)
2

15. Remarks or recommendations of Controlling Officer:

Signature (with date)

Designation

Certificate regarding admissibility of leave

(By Accountant General (A & E) in the case of Gazetted Officers)

16. “Certified that ………………………………………………………......................

(nature of leave ) for ………………………………………..from …………………
to …………………………………is admissible under rule …………………………
of Kerala Service Rules.”

Signature (with date)

Designation
18. * Orders of the sanctioning authority :

Signature (with date)

Designation

* If the applicant is drawing any compensatory allowance, the sanctioning authority should state
whether on the expiry of leave he is likely to return to the same post or to another post carrying a
similar allowance.
 SUBMISSION

I am submitting herewith my leave surrender application for 30 days as

on for further necessary actions.