F O R M - I (See Rule - 14) APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE 1. Name : 2. Post held : 3. Department, Office and Section : 4. Pay : 5. House rent and other compen- : satory allowances drawn in the present post 6. Nature and period of leave : applied for and date from which required. 7. Sundays and Holidays, if any, : proposed to be prefixed/suffixed to leave. 8. Grounds on which leave is : applied for 9. Date of return from last leave : and the nature and period of that leave 10. Propose/do not propose to avail : myself of Leave Travel Conce- ssion for the block years______ ____________ during the ensu- ing leave 11. Address during leave period : Signature of applicant with date 12. Remarks/Recommendation of the Controlling Officer. Signature (with date) Designation
