1. 2. Name Post held 3. 4. Department,Office and Section Pay 5. 6. 7. 8. 9. 10. 11. Address during leave period avail myself of Leave Travel Concession for the block years during the ensuing leave Signature of applicant 12. Signature Designation Published on National Portal of India (india.gov.in) F O R M - I (See Rule - 14) date APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE Rs. /- House rent and other compensatory allowances drawn in the present post Rs. /- Rs. /- Nature and period of leave applied for and date from which required. ToFrom Sundays and Holidays, if any, proposed to be to leave. prefixed/ suffixed Yes No Grounds on which leave is applied for Date of return from last leave and the nature and period of that leave ToFrom Propose/ do not propose to Remarks/Recommendation of the controlling officer date
