भा र ती य ूौ

ो िग क सं ःथा न गाँ धी न ग र
INDIAN INSTITUTE OF TECHNOLOGY GANDHINAGAR
छुट का आवेदन/
न Leave Form

आकःमक छुट/Casual Leave प'रवित!त छुट/Commuted Leave

काया!थ! याऽा/ Travel on Duty अवकाश/Vacation
अज!त छुट /Earned Leave )पतृ+व/ूसूित छुट/Paternity/Maternity Leave
अध! वेतन छुट/Half Pay Leave )वशेष आकःमक छुट /Special Casual Leave
असाधारण छुट/Extra-Ordinary Leave ूितबंिधत छुट/Restricted Holiday

1. नाम/Name: ______________________________________

2. पदनाम/Designation: _______________________________

3. कम!चार कोड/Emp.Code:____________________________

4. )वभाग/अनुभाग/Department/ Section:____________________________

5. छुट क अविध/Period of Leave, से/from _________________तक/to _________________

6. छुट क सं3या/Number of Leaves ______________ 4दन/days

7. उपसग!/Prefix ___________________

8. ू+यय/Suffix ___________________

9. छुट का ूकार/Nature of Leave _______________________________

10. उ6े ँय/Purpose: _____________________________________

11. छुट के दौरान पता (फोन/मोबाईल नंबर स4हत)/Address during leave (with Telephone /Mobile No.)

_________________________________________________________
_________________________________________________________
4दनांक/Date: __________________________ हःता<र/Signature: _______________________

ूा=यापक ूभार /अनुभाग ूभार क िसफा'रश/)वभागा=य<

Recommendation of Professor-in-charge/Section In-charge/HOD
.

ूा=यापक ूभार/अनुभाग ूभार के हःता<र/

Signature of Professor-in-charge/Section In-charge (_________________________)
ूशासन >ारा 4ट??णी /Endorsement by Administration

पया!@ छुट उपलAध है , अत: अनुमो4दत 4कया जा सकता है /Adequate leave is available and can be approved

जमा छुट क सं3या/No. of leaves at credit: ___________ हःता<र/Signature _______________

अनुमोदनाथ!/For Approval

कुलसिचव/ूा=यापक ूभार/िनदे शक/Registrar/Professor-In-charge/ Director