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LEAVE APPLICATION FORM

LOCATION :
Setiabudi Office DATE : 19/11/2023

APPLICANT'S NAME :

PLEASE TICK
ANNUAL LEAVE
TYPE OF LEAVE
NO PAY LEAVE

MEDICAL LEAVE

IF OTHERS, PLEASE STATE :

DATE OF LEAVE 22 November 2023 23 November 2023


TO

NO. OF DAYS 2

REASON Family Matters

ADDRESS DURING
ABSENCE Bekasi

LEAVE BALANCE 0

APPLICANT'S SIGNATURE HEAD OF DEPARTMENT APPROVAL

NOTE TO ALL: PLEASE SUBMIT YOUR LEAVE APPLICATION FORM NOT LATER THAN 3
DAYS BEFORE THE START OF YOUR LEAVE. ALL LEAVE APPLICATIONS ARE SUBJECTED TO THE
APPROVAL OF THE HEAD OF DEPARTMENT.

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