art og “THE SECOND SCHEDULE [Pram 3 (ee) Bei) [See Rule 3 (4) ‘orf 1/ FORM 1 ( Pres 14 &e8)/(See Rule 14) repre era sree aA ty site APPLICATION FOR LEAVE OR FOR EXTENSION OF LEAVE 1 reff at arr Name of applicant 2 Post held 3. Ream, rae she agar Department, Office and Section 4a Pay $. agate om og frat aren wars fererar ite sia safer are House rent and other compensatory allowances drawn in the present post 6. Hit ay stare aA res, ore ote eT aw a @ are Nature and period of leave applied for and date from which required 7. etary site sracore we feat wg wt fore sree & Geci/are 4 site ated 81 ‘Sundays and holidays, if any, proposed to be prefixed! suffixedto leave .* 8 amp wT BT Grounds on which leave is applied for 9, fet srrorer af ote Ah ater ste oe sraHTe wt Roe ote seat Date of return from last leave, and the nature and period of that leave to, Aer fee sm sere # = auf & fery srrare arn Rare a a 8/ael | propose/do not propose to avail myself of leave travel concession for the block years during the ensuing leave. 1, see@ret 6 eh Fe ‘Address during leave period Date. 12, Param after’ af feaachh sttean Repeat Remarks and/or recommendation ofthe Controlling Officer Date. BRTER/ Signature. GH, Designation, sell & eecmere Signature of Applicant& oreeorer A orga Bare A eA CERTIFICATE REGARDING ADMISSIBILITY OF LEAVE 15, senha fren aren A * “arm fet fry testa Pea dar (arvana) Prrach, 1972 3 Frew oni rore fire) srg ty Certified that (Nature of leave) or. (Peri from to. isedmissible under Rue of the Central Civil Services (Leave) Rules, 1972. Be RRR/Signatre {BEAT Designation 14, rman wttg 8g war ATE B aR Orders ofthe authority competent vo grant leave aes BReI/Signamre RAT Designation. ‘of pill at ate wftrare oe Proton 8 oh agg) eA are sion eh ae Fore Tey Ae ormemrer yer eM oR Bre wt sett a eo Pe BH oe oe ates A omen & a Al Grek ge geo GI AFT Peta el “If the applicant is drawing any compensatory allowance, it should also be indicated in the orders on the expiry of leave. the Government servant is likely to return to the same past orto another post carrying similar allowance. WHTAYea / MGIPTKol—42 Civit2010-11—«C-42)-—09-01-21