FORM OF APPLICATION FOR EARNED LEAVE

(SEE SUPPLEMENTARY RULE 216)

Note: Items 1 to 12 must be filed in by all applicants whether Gazetted or Non-Gazetted.

01 Name of the applicant Priya.

02 Leave rules applicable As per revised rules.
03 Post held Multi Tasking Staff.
04 Department, office and section O/o. Commissioner of Income Tax (Appeals)-2,
Aurangabad.
05 Basic pay Rs 18000/-
06 House rent allowance, conveyance As per revised rules.
allowance, or other compensatory
allowance drawn in the present post
07 Nature and period of leave applied for and Earned Leave of 04 days:-
date from which required 05/03/2019 to 08/03/2019
08 Sundays and Holidays, if any, proposed to Prefixed: 02/03/2019, 03/03/2019, 04/03/2019
be prefixed/suffixed Suffixed: 09/03/2019 and 10/03/2019
09 Ground on which leave is applied for Domestic.
10 Date of return from last leave and the As per record.
nature and period of leave
11 Address during the leave Shillong, Meghalaya.
12 I propose to avail myself to Leave Travel No.
Concession for the Block Year during the
ensuing leave

13(a) I undertake to refund the difference between the leave salary drawn during leave on
average pay/commuted leave and that admissible during leave on half average pay/half
pay leave which should not have been admissible had the provision to FR 81(b)(ii) rule II
c(iii)of the Revised Leave Rules, 1993, not been applied in the vent of my retirement from
service at the end or during the currency of the leave.

(b) I undertake to refund the leave salary drawn during leave not due, which would not have
been admissible had FR 81(c) Rule- 11 of the Revised Leave Rules, 1993, not been applied
in the event of my voluntary retirement or resignation from service at any time until I earn
half pay leave not less than the amount of leave not due availed of by me.

(Priya)
Date: (Sign of the applicant)
14. Remarks and/or recommendation of the Controlling Officer:
 CERTIFICATE REGARDING ADMISSIBILITY OF LEAVE
Certified that the leave applied for is admissible to the official as mentioned above.

Date:-
Signature:

Designation:

15. Order of the sanctioning authority :

Date:- Signature:

Designation: