FORM 1

[ See rule 15 ]

APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE

1. Name of applicant: _____________________________________

2. Post held: _____________________________________________

3. Department/Office: _____________________________________

4. Pay: __________________________________________________

5. House rent and other compensatory 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

of period of the leave :______________________________________

10. Address during leave period:_________________________________

11. In the event of my resignation of voluntary retirement from services, I undertake to refund: -

i. The difference between the leave salary drawn during commuted leave and that admissible during half pay leave, which would not have been admissible had sub–rule (i) of rule 29 not been applied.

ii. The leave salary drawn during leave not due which not have been admissible had sub-rule (i) of rule 30 not been applied.

Signature of applicant (with date)

12. Certificate regarding admissibility of leave:-

Certified that________________________________________(nature of leave)
for (period)________________________________ from______________ to _____________is admissible under rule of the Civil Services (leave Rule, 1979).

Signature (with date)

Designation.

13. Remarks and/or recommendations of the controlling Officer

Signature (with date)

14. Order of the authority competent to grant leave.

Signature (with date)

Designation