CCS (Leave) Rules (See Rule-14) APPLICATION FOR EARNED LEAVE OR FOR EXTENSION ON LEAVE 01. Name of the applicant 03.Department, Office and Section 05. House rent and other compensatory 06.Nature and period of leave applied for and date from which required. 07.Sundays and Holidays, if any proposed to be 08.Grounds on which leave is applied for 09.Date of return from last leave on the nature and period of that leave. 11. Address during leave period 12.Remarks and/or recommendation of the Controlling Officer 02.Post held 04. Pay Rs. /- allowances drawn in the present post. Rs. /- Rs. /- ToFrom prefixed suffixed to leave. Yes No ToFrom 10.I proposed do not proposed to avail myself of leave travel to avail myself of leave travel years during the ensuing leave Signature of Applicant Date Signature Date Designation GOVERNMENT OF ORISSA Published on National Portal of India (india.gov.in) DEPARTMENT OF HOME
