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THE SECOND SCHEDULE
(See Rule 3(h)
FORM 1
(See Rule 14)
APPLICATION FOR LEAVE
OR EXTENSION OF LEAVE
1. Name
of applicant
2. Post
held
3. Department,
Office and Section
4. Pay
5. HRA
& Other CCA drawn in the present Post
6. Nature
and period of leave applied for and
date from which
required
7. Sundays
and holidays, if any proposed to be
prefixed/suffixed to leave
8. Grounds
on which leave is applied for
9. Date
of return from last leave, and the
nature and period
of that leave
10. I propose
/do not purpose to avail myself
of leave travel
concession for the block years
…………….during the
ensuring leave
11. Address
during leave period
Signature of Applicant
(with date)
12. Remarks and /or recommendation of the
controlling officer
Signature (with
date)
Designation
CERTIFICATE REGARDING
ADMISSIBLE OF LEAVE
13. Certified
that…………………(nature of Leave) for …………..(period) from ………………….to ………………is
admissible under Rule ……………of the Central Civil Services (leave) Rules, 1972
Signature (with
date)
Designation
14. *Orders of
the authority competent to grant leave.
Signature (with
date)
Designation