APPLICATION FOR LEAVE

NAME
LEAVE LAST TAKEN
FROM:

TO:

FROM:

TO:

LEAVE DESIRED
REASON FOR LEAVE
ADDRESS DURING THE LEAVE
CITY & COUNTRY
TELE PHONE NUMBER
MOBILE NUMBER
E-MAIL ID
FOR DEPARTMENT HEAD
DATE OF JOINING
LEAVE RECOMMENDATION
FROM: -------------------- TO: -------------------NUMBER OF DAYS
DATE

SIGNATURE
UNDERTAKING

I hereby agree and undertake that I will rejoin duties on or before _____________In case
I fail to do so under any circumstances, the management may take necessary action and
as per labour law. I will not be entitled for any terminal benefit & will enter on a fresh
contract. The consequent disciplinary action has already been explained to me duly
translated in my vermicular and I hereby undertake to abide by the same.
----------------------------------APPLICANTS SIGNATURE