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BENSHIELD SDN BHD

NO 101-2 JLN RIMBUNAN RAYA 1,


LAMAN RIMBUNAN KEPONG, 52100 KUALA LUMPUR
TEL: 03 6250 6699

LEAVE APPLICATION FORM

EMPLOYEE NAME : : SITI NUR JANNAH BINTI TOTAL ANNUAL LEAVE : - NIL
AMIR SHARIFUDDIN

NRIC NO : 990227-01-5502 TOTAL MEDICAL LEAVE : -

DESIGNATION : CONCIERGE SERVICE BALANCE AL AS AT TO-DATE :-

BALANCE MC AS AT TO-DATE :-
DATE OF : 27.11.2020 / FRIDAY
APPLICATION

NATURE OF LEAVE : UNPAID LEAVE

REASON FOR LEAVE : AS PER ATTACHED, II HHAVE A APPOIMENT WITH DOCTOR DUE TO
MY ILNESS AND NEED TO DO SURGERY TO REMOVE IT .

PERIOD OF LEAVE : 24.12.2020 - THURSDAY

NUMBER OF DAYS APPLIED :1 days

BALANCE AL :- days

MEDICAL CERTIFICATE NUMBER :-

CLINIC / HOSPITAL NAME :-

SIGNATURE OF EMPLOYEE

For Management Purpose Only

LEAVE APPROVED / NOT APPROVED

SIGNATURE OF EMPLOYER / HOD

DATE

Note : Annual Leave must be must be applied for upon at least 2 weeks prior written notice and
must be approved in writing by the employer

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