INDIAN INSTITUTE OF TECHNOLOGY,BOMBAY

APPLICATION FOR LEAVE

NOTE : ITEMS 1 TO 9 MUST BE FILLED IN BY THE APPLICANT

1. Name
2. Designation
3. Deptt./Section
4. Nature of leave
Period From To
Holiday's,if any proposed to be Date Day
Prefixed / Suffixed Prefix
Suffix
7. Grounds for leave
8. Whether the applicant proposes to avail of leave travel concession during the ensuring leave Yes No
9. Address while on leave

10.

  1. In the event of my resignation or voluntary retirement from the service , I undertake to refund :
    • The difference between the leave salary drawn during commuted leave and that admissible during half pay leave.
    • The leave salary drawn during leave not due.
  2. I also undertake to refund the leave salary drawn for the period of Earned Leave which would not have been admissible, had that leave not been credited in advance in the event of my resignation, voluntary retirement, dismissal or removal from service or in the event of termination of my services.

Date :

Signature of Applicant

11. Remarks and / or recommendation of the Controlling Officer

Signature

Date :

Designation

12. Certified that the following leave is admissible to :

Name
Designation
Deptt. / Section
Kind of leave (To record Prefix and Suffix if any ) Period
No. of days From To
Balance of leave Earned leave Days/Half pay leave Days

Signature

Supdt./Office Assistant

13. Orders of Sanctioning Authority

Signature

Registrar/ Dy. Registrar/ Asstt. Registrar