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1* glE, fu*TFi, DEPARTMENT oF POST I NDI ASilal.,Sqrqrd -

FORM OF APPLICATION FOR LEAVE

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Note - ltems I to ll must be filled in by all applicants whether gazetted or non-gazetted

f . $S SI TfrT/ Name of Appticant

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Department, Office and Section

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srRI qdl qr 3lq qftrsq ffiHouse rent allowance, conveyanceallowance or other compensatoryallowance, drawn in the present post

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Sunday and holidays, if any proposed tobe _prefixed/suff ixed to leave,

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Date of return from last leave, and thenature and period of that leave.

r r.t{rk{Ksinrql€fr ...... * sueqfr*fdq*tqnr+1*FrT(dimr tZrfi t/ I propose/do not propose to avail myself of leave travel concession in theblock_.years............ ...... during the ensuinq leave.

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,.'P.B.-W,1983i;ffiq11(q)-tullfrdrgi.a+q{.iTqq,q'+trrr(a) I undertake to refund the difference between the leave salaiy {pwn during leaveon averagepaylcommuted leave and that admissible du.ring leave on 6af iverige day half puy-6"r",which would not have been admissible had. the.firovio to F.R. BiabiItTrIJ5 iijiliiiil Ir tn"Revised Leave Rules, 1983, not been.applied in tne Lveni oiry'idtirerent from service atthe end or during the currency of the Ldave

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b) I undertake to retu'rn the leave salary drawn during "have not due" which would not have' been admissible had F.R.81(c) Rulti t1 (lll) of th6 Revised Leave Hule, 1983 not beenapplied in the event of my voldniary retirement or resignation.from service at any time untillI

'e'arn half pay leave,not-less than'the amount of leave-not-due availed of py me. :

nfi€'Date

qPtr * 6{f,rs{Signature of applicant

6€TTq{'/ Signature

TtrTfql Designation ...

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1 3. frqqur oTFrfirfr fl M efuzqr ffi-{rRemarks and/or recommendation of theControlling Officer.

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CERTIFICATE REGARDING ADM]SSIBILITY OF LEAVE

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(By Accountant General in the case of gazetted officer)

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Certified that (Nature of leave)

(Period)

is admissible under rule ......... ..... of the

nrfrWDate .......rs. * ffiffriffiqffit g{rhT --" Orders of the sanctioning authority :

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6ffif{{/ Signatureqtr{fq/ Designation ............

6KTffi/ Signature

qfl:q/ Designation

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lf the applicant is drawing any compensatory allowance, the sanctiong authority should

state whether on the expiry of leave he is likely to return to the same post or to another post

carrying a sirnilar allowance.

Ptg/3- 1 4 1 /0 1 -02dt. 1 41 1 /04 2 lakha, G. P. Press