(FORM - 1) (See Rule 14) APPLICATION FOR LEAVE OR EXTENSION OF LEAVE 1. Name of applicant : _________________________________________________ 2. Post held : ________________________________________________________ 3. Department Office & Section : ________________________________________ 4. Pay : _________________________ 5. House rent and other compensatory allowance drawn in present post : _____________________________________ 6. Nature and period of leave applied for and date from which required : _____________________________________ 7. Sunday and holidays, if any Proposed to be prefixed Suffixed to leave : ______________________________________ 8. Ground on which leave is applied for : ______________________________________ 9. Date of return from last leave and the nature and period if that leave: ________________________________________ 10. I proposed /do not proposed to avail myself of leave travel concession for the block years _______ during the ensuing leave : ____________________________________ 11. Address during the leave period : ______________________________________ Signature of Applicant (with date) 12. Remarks and /or recommendation of the Controlling office Signature (with date) Designation CERTIFATE REGARDING ADMISSIBLITY OF LEAVE 13. Certified that ______________________________________ (nature of leave) for ________________ period from ___________ to __________________ is admissible under Rule ________________ of the Central Civil Service (Leave) Rules, 1992. Signature (with date) Designation
