FROM OF APPLICATION FOR LEAVE (EL/HPL/CL/OH/ANY OTHER LEAVE
1 Name of the applicant : B.E.Nageswara Rao
2 Designation : Junior Assistant
3 Department, Office and Section : I.M.S, ESI Hospital, VIJAYAWADA
4 Pay : 52,600 /-
5 House rent allowance, Conveyance : -
allowance or other compensatory
allowances drawn in the present post.
6 Nature and period of leave applied for : CL-1 on 21-08-2025
and date from which required.
7 Whether permission to leave the : -
Headquarters or not
8 Sunday and holidays, if any proposed : -
to be prefixed/sufficed to leave.
9 Ground on which leave is applied for : Personal work
10 Date of return from last leave, and :-
nature and period of that leave.
11 Address for communication during :-
Leave
12 Contact Number (mandatory) : 8367475186
13 Leave eligibility as per S.R (certified by : -
the concerned Office Superintendent)
14 No. of CLs/OH availed so far (certified : -
by concerned Officer)
Date: 20-06-2025 Signature of the applicant
15 Remarks and/or recommendation of the :
Reporting Officer/ Controlling Officer.
Date: Signature……………………….
Designation…………….………
16 Orders of the sanctioning authority :
Date: Signature……………………….
Designation………………..…...
FROM OF APPLICATION FOR LEAVE (EL/HPL/CL/OH/ANY OTHER LEAVE
1 Name of the applicant :
2 Designation :
3 Department, Office and Section : I.M.S, ESI Hospital, VIJAYAWADA
4 Pay :
5 House rent allowance, Conveyance :
allowance or other compensatory
allowances drawn in the present post.
6 Nature and period of leave applied for :
and date from which required.
7 Whether permission to leave the :
Headquarters or not
8 Sunday and holidays, if any proposed : -
to be prefixed/sufficed to leave.
9 Ground on which leave is applied for :
10 Date of return from last leave, and :
nature and period of that leave.
11 Address for communication during :-
Leave
12 Contact Number (mandatory) :
13 Leave eligibility as per S.R (certified by : -
the concerned Office Superintendent)
14 No. of CLs/OH availed so far (certified : -
by concerned Officer)
Date: 06-06-2025 Signature of the applicant
15 Remarks and/or recommendation of the :
Reporting Officer/ Controlling Officer.
Date: Signature……………………….
Designation…………….………
16 Orders of the sanctioning authority :
Date: Signature……………………….
Designation………………..…...