(See S.R. 3 below S.R. 74)
APPLICATION FOR LEAVE
(For both Gazetted & Non Gazetted Govt. Servants)
Note:- Items 1 to 10 must be filled in by all applicants whether Gazetted or Non Gazetted. Items 13 apply only in the case of Gazetted officers Items 14 & 15 apply in the case of Non Gazetted officers.
Name Of Applicant
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Leave rules applicable
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Post Held
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Department or Office
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Pay
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House rent allowance, conveyance allowance or other Compensatory allowances drawn the present post
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Nature & period of leave applied for and date from which required
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Ground on which leave is applied for
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Date of return from last leave and the nature & period of that leave
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Leave address, if granted
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I undertake to refund the difference between the leave salary drawn during leave on average pay/commuted leave and that admissible during leave on half average pay/half pay leave, which would not have been admissible had the provision to F,R, 81(b)(II)M.B.F.R. 79(c) Rule 11(c) of the revised leave Rules 1933/Rule 14(c) of Madhya Pradesh Revised Leave Rules, 1934/Rule 963(c) of Rajasthan Service Rules, Not been applied in the event of my retirement from the service at the end or during the currency of the leave.
Date:- _ _ _ _ _ _ _ _ _ _
Remarks and/or recommendation of the Controlling Officer.
Date:- _ _ _ _ _ _ _ _ _ _
Report of the Audit Officer.
Date:- _ _ _ _ _ _ _ _ _ _