Company Name & Logo LEAVE APPLICATION FORM

Name of the Employee Designation / Department Leave Period No. Of Days Purpose of Leave : ______________________________________ : ______________________________________ : From ________________ To ______________ : ______________________________________ : ______________________________________ : ______________________________________ Nature of Leave: (Tick where applicable): Casual Leave (CL) / Earned Leave (EL)/LOP

Date of Application
LEAVES AVAILABILITY CASUAL LEAVE SICK LEAVE

Signature of Applicant

EARNED LEAVE

HR DEPT APPROVED / REJECTED (If REJECTED STATE REASONS)

HOD WHETHER COMMUNICATED TO THE EMPLOYEE HR DEPT

Notes: Sick leave if taken more than 3 continuous days would have to be supported by doctor's certificate. Leave would be earned on a per month basis. Leave sanction would be given on the basis of the number of leaves credited while applying for leave. For further details please refer to the Leave Policy