Name of Applicant | ; |
Post Held | ; |
Department/Office/Section | ; |
Pay Drawn | |
House Rent and other Compensatory allowances drawn in the present post | ; |
Nature of leave applied for | ; |
Period of Leave required | ; |
Date from which required | ; |
Saturdays, Sundays & holidays, if any, proposed to be prefixed/suffixed to leave | ; |
Grounds on which leave is applied for | ; |
Date of return from last leave and the nature and period of that leave | ; |
Address: Local | ; |
Permanent | ; |
During the leave period | ; |
I propose/do not propose to avail of LTC for the block years_____________during the ensuing leave.
(Signature of the applicant with date)
Remarks/Recommendations of the
Controlling Officer____________________________
(Signature & designation with date)