Effective Date: 01-11-2021
Document Code:
LEAVE APPLICATION
IMS-RM-F05
Rev. No. 00 Ref #:
Please ensure that this application is approved prior to confirming your holiday arrangements.
Annual Leave □ Emergency Leave □ Other
Surname (Mr/Mrs/Miss)
First Name
Branch/Department Employee Payroll No.
Job Title
Reason for leave:
First Day of Leave Last Day of Leave Date returned to work No. of leave days taken
Leave Entitlement:
Total days remaining after Current year leave Additional leave days
Date Joined Date last leave taken
previous leave entitlement requested
Ticket □ Paid by Company □ Own ticket
Contact details whilst
on holiday (Tel / Fax
No. if applicable)
Other Requests
Details of Flight Booking:
Passport No Nationality
Passport Expiry Date Residence Visa Expiry
Travel Date & Time (am/pm) Return Date & Time (am/pm)
Flight No. Departure (Airport) Destination (Airport)
Please attach details as above for others due to travel with you under your Contract
Employee’s Signature _______________________________ Date _________________________
Authorisation Details: I have approved the holiday dates requested above:
Name Signature Date
Operations Manager
HR Manager
Accounts Manager
□ Passport checked for Visa & Expiry Dates
□ Ticket Booked
□ Passport Retrieval Request Form