¸üÖ™ÒüßµÖ ÃÖæ“Ö−ÖÖ - ×¾Ö–ÖÖ−Ö ëú¦ ‹ÃÖ. †Ö¸ü.

-1
NATIONAL INFORMATICS CENTRE S.R.-1
”ãû¼üß êú †Ö¾Öê¤üú úÖ ±úÖ´ÖÔ / FORM OF APPLICATION FOR LEAVE
×™ü¯ÖÖß - ´Ö¤ü ÃÖӏµÖÖ 1 ÃÖê 11 ŸÖú ¯ÖÏŸµÖêú ¯ÖÏÖ£Öá úÖê þÖÓµÖ ³Ö¸ü−Öß “ÖÖ×Æü‹, “ÖÖÆêü ¾ÖÆü ¸üÖ•Ö¯Ö×¡ÖŸÖ ÆüÖê µÖÖ †¸üÖ•Ö¯Ö×¡ÖŸÖ …
NOTE: Items 1 to 11 must be filled in by all applicants whether gazetted or non-gazetted.

1. ¯ÖÏÖ£Öá úÖ −ÖÖ´Ö / Name of applicant :-----------------------------------------------------

2. ¯Öü¤ü / Post held :-----------------------------------------------------
3. ×¾Ö³ÖÖÖ ,úÖµÖÖÔ»ÖµÖ †Öî¸ü †−Öã³ÖÖÖ / Department, office and section :-----------------------------------------------------
4. ¾ÖêŸÖ−Ö / Pay :-----------------------------------------------------
5. ¾ÖŸÖÔ´ÖÖ−Ö ¯Ö¤ü ¯Ö¸ü ×´Ö»Ö−Öê¾ÖÖ»ÖÖ ´ÖúÖ−Ö ³Ö¢ÖÖ, ÃÖ¾ÖÖ¸üß ³Ö¢ÖÖ µÖÖ †−µÖ ¯ÖÏן֍úÖ¸ü ³Ö¢Öê … :-----------------------------------------------------
5. House rent allowance, conveyance allowance, or other compensatory:-----------------------------------------------------
allowance drawn in the present post. :-----------------------------------------------------
6. ´ÖÖӐÖß ÖµÖß ”ãû¼üß úß ×úÃ´Ö †¾Ö×¬Ö †Öî¸ ˆÃ֍êúÓ ¿Öã¹ý ÆüÖê−Öê úß ŸÖÖ¸üßÖ :-----------------------------------------------------
6. Nature and period of leave applied for and date from which required. :-----------------------------------------------------
ü7. ¸ü×¾Ö¾ÖÖ¸ü †Öî¸ ”ãû¼üß êú פü−Ö, µÖפü úÖê‡Ô ÆüÖê, וÖ−Æêü ”ãû¼üß êú ¯ÖÆü»Öê / ²ÖÖ¤ü ´Öë •ÖÖê›−ÖÖ “ÖÖÆŸÖê Æïü… :-----------------------------------------------------
7. Sundays & Holidays if any, proposed to be prefixed/suffixed to leave. :-----------------------------------------------------
8. ”ãû¼üß úÖ úÖ¸üÖ / Ground on which leave is applied for :-----------------------------------------------------
9. ׯ֔»Öß ”ãû¼üß ÃÖê »ÖÖî™ü−Öê úß ŸÖÖ¸üߏÖ, ˆÃÖ ”ãû¼üß úß ×úÃ´Ö ŸÖ£ÖÖ †¾Ö×¬Ö :-----------------------------------------------------
9. Date of return from last leave, and the nature and period of that leave.:-----------------------------------------------------
10. ´Öê¸üÖ ×¾Ö“ÖÖ¸ü †ÖÖ´Öß ”ãû¼üß ´Öë ---------------------- êú Ö›ü ¾ÖÂÖÖì êú ×»ÖµÖê ”ãû¼üß µÖÖ¡ÖÖ úß
׸üµÖÖµÖŸÖ »Öê−Öê úÖ Æîü / −ÖÆüß Æîü :-----------------------------------------------------
10. I proposed/ do not propose to avail myself of Leave Travel
Concession for the block years.-----------during the ensuring leave. :-----------------------------------------------------
11. ”ãû¼üß úß †¾Ö׬ִÖë ¸Æüü−ÖêúÖ ¯ÖŸÖÖ / Address during leave period :-----------------------------------------------------

ŸÖÖ¸üßÖ / Date :------------------- ¯ÖÏÖ£Öá êú ÆüßÖցָ / Signature of applicant :---------------------

12 ×−ÖµÖÓ¡ÖÖ †×¬ÖúÖ¸üß úß ×™ü¯¯ÖÖß †Öî¸ / µÖÖ ÃÖÓßÖãןÖ

12. Remarks and/or recommendation of the Controlling Officer
ŸÖÖ¸üßÖ / Date :------------------- ÆüßÖցָ / Signature :---------------------
¯Ö¤Ëü−ÖÖ´Ö / Designation :---------------------
”ãû¼üß úß †−Öã´ÖŸµÖŸÖÖ êú ²ÖÖ¸êü ´Öë ¯ÖÏ´ÖÖÖ ¯Ö¡Ö /Certificate Regarding Admissibility of Leave
13. ¯ÖÏ´ÖÖ×ÖŸÖ ×úµÖÖ •ÖÖŸÖÖ Æîü ׍ú ----------------------------------ÃÖê ---------------------ŸÖú --------------------פü−Ö êú ×»ÖµÖê ×−ÖµÖ´ÖÖ¾Ö»Öß êú ×−ÖµÖ´Ö
------------------------êú †¬Öß−Ö -------------------------------------------------†−Öã´ÖŸµÖ Æîü …
(”ãû™ü™üß úß ×úÃ´Ö )

(nature of leave)
13. Certified that----------------------------------for------------days --------------------from-----------------------to------------------
is, admissible under rule---------------------of the C. C. S. (Leave) Rules,1972
ŸÖÖ¸üߏÖ/Date :------------------- ÆüßÖցָ / Signature :---------------------
¯Ö¤−ÖÖ´Ö / Designation :---------------------
14. *þÖߍéú×ŸÖ ¤ê−Öê ¾ÖÖ»Öê †×¬ÖúÖ¸üß êú †Ö¤êü¿Ö / Orders of the sanctioning authority:-
ŸÖÖ¸üߏÖ/Date :------------------- ÆüßÖցָ / Signature :---------------------
¯Ö¤−ÖÖ´Ö / Designation :---------------------

------------------------------------------------------------------------------------------------------------------------------------------------------
*µÖפü ¯ÖÏÖ£Öá úÖê úÖê‡Ô ¯ÖÏן֍úÖ¸ü ³Ö¢ÖÖ ×´Ö»ÖŸÖÖ ÆüÖê ŸÖÖê ´ÖÓ•Öæ¸üß ¤êü−Öê ¾ÖÖ»Öê †×¬ÖúÖ¸üß úÖê µÖÆü ׻֏Ö−ÖÖ “ÖÖ×Æü‹ ׍ú ”ãû¼üß ¯Öæ¸üß ÆüÖê−Öê ¯Ö¸ü ¯ÖÏÖ£Öá ˆÃÖ ¯Ö¤ü ¯Ö¸ü µÖÖ ×úÃÖß
‹êÃÖê ¯Ö¤ü ¯Ö¸ü »ÖÖî™ü−Öê úß †Ö¿ÖÖ Æîü µÖÖ −ÖÆüà… •ÖÆüÖÓ ‡ÃÖß ¯ÖύúÖ¸ü úÖ ³Ö¢ÖÖ ×´Ö»ÖŸÖÖ Æîü …
*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.