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Surname: l5 LAlvt

Payroll Numbef: v (t 5o 7
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I hereby aptlY for leave as follow6:


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please circle leav€ type aE applopriais:

i" Fileasc uie ne aiiiiriale form {or Paret al Leave

{f c Cancellation o{ Previous Advice [] Leave io be paid in advance

I Leave to be paid as if in the field (FIFO)

,Applicanl's Sig ature: Iut__1"*_


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