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FORM OF APPLICATION FOR LEAVE

(See Supplementary Rule 216)

1. Name of Applicant

3. Post Held

4. Department, Office and Section

5. Pay

6. HRA / Conveyance / Other Allowances

7. Nature and Period of Leave (Applied For)

7(a). Date from which required

8. Sundays and Holidays proposed to be Prefixed/Suffixed

9. Ground on which leave is applied for

10. Date of return from last leave, nature and period

11. Leave Travel Concession (LTC) Proposal