Name of the Employee : ................................................
Designation : ................................................
Location : ................................................
Nature of Leave to be availed (Earned/Casual/Sick) : ...................................
Duration (3-Days) : From ............. to ..................
Reason for taking leave : .................................................. ...............................
Contact Address and Nos. while on leave ....................................
Contact: ...........................................
Signature ________________________________
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Earned / Sick / Casual Leave granted from _________ to _________ for ______ days
Earned / Sick / Casual Leave regretted due to _______________________________
__________________________________________________ __________________
Date ___________________ Sanctioning Authority__________________
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FOR HUMAN RESOURCE DEPARTMENT ONLY
Date of Receipt of Application : _____________
Leave Due: EL ____ SL _____CL _____ Sig. HR Deptt ______________