C 22/B/Rev.
98
SOUTHERN RAILWAY
Application for L.A.P / L.H.A.P
1.Name Of the Employee. :
2.Staff/Ticket No. :
3.Designation, Office and Station :
4.Leave applied for. : Days, From. To
5.Details of any prefixing./ :
suffixing of holidays
6.Reasons for applying leave :
7.Address during absence. :
(Phone No if any)
8.Signature of the employee : Signature Date
,..................................................................................................................................................
9.Recommendation of the Supervisor:
with signature and designation. : Signature. Date
Designation
……………………………………………………………………………………………………………
(For office use only)
10.No of days of leave at credit. : as on
11. Signature of certifying official with : Signature. Date
designation and office
Designation
Office
……………………………………………………………………………………………………………
12. Orders of the sanctioning authority :Signature. Date
Designation
,.................................................................................................,................................................
13. Balance leave at credit. : as on
14. Certified that the leave account of the : Signature. : Date:
employee has been updated as on. Designation :