r^ l\ tt^.
nt-\ -
LL:rvil.\fLi
,s, " 'i'-)C ilnlS ]/ -iti r-
-- .,: : ii, e:, . r,,: ., it '' !-'i'r -t. -t,l=.I
A-Bplication for leave or for Extensioh of L-Qave
1- qrPft o-r rrq
Name of APPlicant
2. IrE
Post held
3. ftqrrT, atqfaq ogt* tr
Depaftm'ent, Office and Section
4.ry
Pay
t6 tR ffi r '.
ffqyq: Eff,f rffiffef. " ''' "'1 ,
' Ho,use Rent and other compEffSa n'
Allovrm,nees d,awn i'n ..',,1
,,,,
. ,
','..
'6',
qtt s\f$"qJ6 dn fi drffi .';''':i, '
Nla ,e'lid-perio'd of leave apB'iffii: , ',t'
1.
' t..,,, , .::.', .;
..-.',,..',,
:. tiou"ro'S oh whieh,leave is aprpi:ie'd{b'r:
..':'t . .
g. 'ft6'm" tr=dd} € tflfei q't
:, vs,,61-f#g' Holr iirqfu r
, .';',; [)5'tr'p,ro.f€tUrfi, f fei'tn Ia st
', Pe:rio'il'o thAt' leave
r.o,$itr',M{ qq8 d. .**,*",;;;,*;. tt 'trq}' A ffi' ry d'
;;r,nno; ;;;"; prup". to a\reii i'ffifie'are travel eonheetid'ri fior tlre
bloe[< year d u rj fl-$' th"E ehsuirig leave.
r.:: i;2.eil* S,' * .. '.:-i
:i itl
,, :';l-i;,g tl-:c ,, -- r l.-!:-/J
*: l:J'l,
fuilf-o
date yrsft d rwrqt
Signature of applicant
(with date)
12. ft{rqur sTffi at ftqnrft fr Z qr fts
Rernarks and /or recommen.dation of the, controlling officer
ffi+.:
date' E€dfqi'E
Signatu,re (with date)
.
Ir{flq.
Design,atio,n
ge
ftqq
{;'petiod) frortr
of the
€'SfrlfrT.*,j js..!:s-r-L j:.-.!.j.!La:
s ign a'tlrlr, (with date)
oh
6
Orde'rs Of thc authority corhpiere:iit,tu gra,rt,teare
E"{fi.fErc.*..
Sigria,ture,(with date)
ffiE... -=o,.,.,.as. -.r.!........
_
Designation