EC No. : NAME :
 DESIGNATION :
FUNCTION REPORTING MANAGER (Sanctioning Authority) LOCATION
TYPE OF LEAVE PERIOD TOTAL DAYS ON LEAVE LEAVES AVAILABLE LEAVES DUE
C.L M.C.L.
FROM TO
M.L Comp Off ADDRESS WHILE ON LEAVE/CONTACT TELEPHONE NO. PERSON RESPONSIBLE IN ABSENCE
REASON For LEAVE


___________________ ___________________ ____________
HR Department Recommended by Sanctioned by

UNDERTAKING

I undertake that if I overstay on expiry of the sanctioned leave, I shall be marked as absent in my attendance register and if I want to extend my leave, I shall intimate to HR department in due time and in the event of my illness, I shall submit Medical Certificate from the appropriate Medical authority.
Signature of Applicant