To,
The Chairman
Kolkata Primary School Council
27A Bosepukur Road
Kolkata 700042
Sub: Prayer for sanc oning of leave taken from………………………….. to ……………………………
(………….day) as Medical Leave
Through Proper Channel
Respected Sir,
I,………………………………………………………………….…………………. H.T/T.I.C/A.T of
……………………………………………………………………………………………. school, under Circle Alipore,
Dist. Kolkata, joined on ……………………….………… (1st joining date). I have taken leave from
……………………………………… to ……………………………….. (……………….. days) due to …………………
………………………….……………………………………………………………………………………………………..…………..
I resumed my duty on …………………..……….
I am reques ng you to sanc on my aforesaid leave as Medical Leave with
full pay as per your regula on.
Regards
Date:…………………………………..
Place:………………………………….. ……………………………………..
Mobile No. ………………………………………. Signature of Applicant
H.T./T.I.C Note – Forwarded to the office the SIS – Alipore for necessary ac on.
# Enclo- (please a ached the documents
as follows according to serial no.)
1. Resuming Le er (Original) ..……………………………………..
2. Leave Format Signature of H.T/T.I.C
3. Leave Statement
4. Original Fit Cer ficate from registered Doctor Forwarded to the office the Chairman,
5. Photocopy of Medical papers/ Prescrip on K.P.S.C for necessary ac on.
6. Photocopy of 1st Appointment Le er,
7. Photocopy of 1st Joining Le er
8. Photocopy of Transfer Order (if any)
9. Photocopy of Joining le er of present School
(if pt. 8 is yes) ……………………………………………………….
[N. B. – All photocopy should be self-a ested] Signature of SIS - Alipore
For SIS Office use only
Leave in ma on Register Sl no…………………. Date…………………
Submi ed to. ………………………………..
To
The Head Teacher/Teacher -in-Charge Date………………………
……………………………………………………………………………………
……………………………………………………………………………………
Kolkata –
Circle -Alipore
Sub: Resuming duty a er leave
Respected Sir/Madam
With due respect I ………………………………………………………………………….. wish to inform you that
a er availing Medical leave from ……………………………… to ……………………………………. (……………
days). I wish to resume my duty on and from …………………………..
I request your kind self to give me permission in this regard.
Thanking you
Yours faithfully
……………………………………………………………..
Signature of applicant teacher
Designa on…………………………
School Name…………………………………………………………………
H.T/T.I.C note-
………………………………………………………………………… resumed his/her duty a er availing medical
leave as on…………………………….. at …………………
Forwarded to SIS – Alipore
………………………………………………………………………………….
Signature of H.T/T.I.C with date and seal
APPLICATION FOR APPROVAL / SANCTION OF LEVAE -MEDICAL/COMMUTED
MATERNITY / EXTRA ORDINARY IN TRIPLICATE
ALIPORE - CIRCLE
1. Name of the Teacher … ….
(in Block Letters)
2. Designation … ….
3. Name of the School where working
with address … ….
4. Date of Approval … ….
5. Date of Confirmation … ….
6. Leave at credit with statement of leave in
duplicate (commuted leave with full pay
against half pay) … ….
7. Details of leave enjoyed previously
(nature of leave with period to be mentioned
particularly) … ….
8. Balance of leave at credit upto (after
deduction of leave already enjoyed) … ….
9. Details of leave applied for (nature of leave
with period to be mentioned) … ….
10. Attested copies of resolution of the M.C. sanctioning
such leave is / are enclosed or not … ….
11. Details of maternity leave prayed for (date confine-
Ment to be mentioned with M.C mentioning date of
Child birth) … ….
12. Details as to No. with date(s) period or after leave
enjoyed / taken … ….
13. Date of resuming duty in the school after enjoying
leave (supported by an application duly counter-
signed by the Secretary / President / Administrator
and the Head-Teacher … ….
14. Details of previous leave enjoyed / taken / sanctioned
entered in the Service Book or not … ….
(Service Book and the Leave Register with entries
to be shown to the Circle Inspector of Schools con-
cerned for verification and counter-signature)
(1)
(2)
Details of enclosure (s)
(1)
(2)
(3)
(4) …………………………………………………
Signature of the Teacher with date
…………………………………………………….…
Signature of the Head Teacher /T.I.C with seal
Counter signature of the Secretary / President / Administrator & the Head Teacher with date. Seal of designation and seal of
the school. Remarks / Recommendation of the Circle Inspecting Officer concerned. The action taken by the Managing
Committee / President / Administrator in sanctioning the medical / commuted / maternity leave with full pay / half pay on medical
ground / private affairs from ……………………………………is verified with Leave Register along with other necessary papers
/ documents etc. are recommended / or approval / not admissible under the rules.
Signature of the Circle Inspector of Schools
with Seal and Date
Memo no …………………………………….. PG Dated / Calcutta the July, 1981
May be approved / granted Approved / granted
District Inspector of Schools
Asstt. Inspector of Schools (Pry. Education) Kolkata
(Pry. Education) Kolkata
LEAVE STATEMENT
Name of the Teacher …………………………………………………………………………………………………………
Date of Birth ……………………………………………… Designa on ………………………………………...
Date of Appointment ………………………………………….. Date of Re rement ……………………….……
Name of the School …………………………………………………………………………………………………………..
Circle – Alipore
Period of Period of Leave Leave Medical Leave Balance
Balance Medical
Remarks
Duty Leave Earned Credit Leave Enjoyed
Form To Form To H.P.L COM H.P.L COM Earned Credit H.P.L COM H.P.L COM
01.01. 31.12
15 15 15
2020 .2020
01.01. 31.12
15 15 30
2021 .2021
01.03. 10.03. Already applied for sanc oning 10 20
2022 2022
01.01. 31.12
15 15 35
2022 .2022
01.04. 15.04.
15 20
2022 2022
…………………………………………………………… ……………………………………………………………
Signature of the Head Teacher /T.I.C with seal Signature of S.I.S
