gq.A ftt siff o.

r w,rd
FORM OF APPLICATION FOR LEAVE
(srgqro Hqfr 21 6 ffizSee supplementary Rule 2l6t
ftqvft: aE zieqr r * 1 r !-6+-6 qreff o] &r.ff qrBs qG a-a srqqBd d qr srcrqqBfr r

Note:- Item l to I I Must be filled in by all applicants whether gazzated, or non-gaz zated

1. qreff or ara
2. arg #
Name of applicant:
qrffi gEA
4^t v,r
tr+e-+rrs-m
Leave rules applicable CCS Leave Rule, I972

3. qezPost held 4-t P - Pnv

4. f?a+rar,o-rqfarq siz srgarrur
Department, Office and Section D4lc Sr.ro+la, Deit"
".le'-?
5. trazPay LLzoo {- L/t
6. q-dflrd rrc q-{ Ba-+ ETdr a-ord ftE-rrqr
era(il/trqr8 a{ailr qr 3rq !ft?5]u ai*
House rent allowance, conveyance allowance *s ^/.r4.; Ue
or other compensatorv allowance drau,'n in
the present post.
1. ai"ft rrS gqe 6t b-rqusrEB
s*r sEr* gF ff d arrftszNature
E L {rl0 t+L/,
and
period of leave applied for and date from which lS,lo.lo)-Y twM
required.
8. s}z ge--& S R-a qR +t€ d,
ztr{Erc
ilEe gq& i q-a&rqre fr d-s.ar qrai I tr.t"'rv ?
Sundays and holidays. Ifany proposed to be
E r

(u w.u i
prefi xed/suffi xed to leave.
9. gq& tnr o-rwr
Ground on which ieave is applied for. \d^l 6--.*4A
i0. M eq& i # zfr arfts
sfu Jrr trqA Efi fr{q aen srqfET
Date of return from last leave and the nature
and pcriod ofthat leavc.

11. frzr I?-rrs srronaft ge-..a 4..... . ........t:/.0................+ s-s qfr +

fri-+ gu& vr+r e&
*B-s-d i* oI B lzI propitsed to avail rnyself of leave concession in the block years...........
during the ensuing leave.

{d-n- e.',a/qftatra eqa efi srEfET fr fta-} ur+ gqe }a-a sn-z
t2.
!T), t_=T^a--^{
slr€I^a-d-a df gE.'A tiF^3i{d
ffi qre a-d-d t srffi{ +1 sE+ so-a en} arquT 6z.pitA gq& Eff
zrafrE qz sreIErT =-tr-d +{rdl *t ffi+gF # Ee fr€Tfr d qd Bq-+r 8 r G) (, ,lftimg-d
fi;rs-trrilfr, re33 a Bq-fl r r(ur)(rrr) d drg a ari qz srgH= a.ffiz
(a) I undertakc to refund the diff-erence bctween the leave salary drawn during the leave
on average pay,
conrmuted leave and that adrnrssible during the leave on behalf average paylialfpay leave,
wtrictr wouiO
not have been admissible had the provision to F.R. 8 (b) (ii) rule f f (c;
llli; of the itevised
1933, not been applied in the event of my retirement from service at the end or during the
Leave Rules,
currency of the
leave.
AAOiAdrnin-ll'
Please report Adrnissibility of Leave'

AAO/

(a) * a+a tm { q't et T+€r A ffigd Ae qr A-qr i arar qe H ge-a

aE 1fr-* o-a sn*
+- *zrq d u_d
ffi arBa gqq ae- fr e at A sTEra
";'"-J'ftta
# .+ --A ,ff; ;1 ffi{
E;-'8i(,,),.,;if# ('i) "r-A 1e33 a
B**=d -re 6- =t 65 vrfr' Era
q-{
ftrs-in
.

have been admissible had

,?."ilH,,ff.rT*g, drawn during "reave not due"which woutd not
ffifr.ffi.
g1 11 (d) of the Revised r-.*. Rules'
(c) Rule
1i33 not been applied, In the event of my
voluntary retirement
F,.R.
I earn harf pay reur. notless than the
amount of leave not due availed
or resignation from service at any time until
of by me.

qrfr * aFTerE
artg, Signature ofapPlicant

Date: I

13 B"-Eiaur srfEror-B d trur"ftt

tl'rlr
oft SHARMA'
Rernarks and/or recommendat'o
o lli c er'

#ffi*';lfir''i:i' ararerzzSignature
qearazDesignation
arftr,rzDate:

gq-A at 3{gal@-dr A oft A qflrurq{ oF LE AvE

c"nir r c lr E net enp IN G ADMI IB ILITY ss

;;;;
t t

;,fleorft.it d aar-&srors
zioer *
errr
In the case of gazzated officer )
1By Accountant General

ka a ftra
eqa Eft fu-rn)

srga-tu B r ^rr^...,^\ r^*""""""" .from" ......... to

(Nature of leave) for
Certified that........." ;,.;L"t
it.a*ittiui. *,r0.' t'r" " """"" ' of the """" ' 'Rules'

arnrer:zSignature
rrelaralDesignation
ar$srDate:

. g*qft ae cre s+fEror8 6 snler

r Ortler of the Sanctioning authority

,,,

aranerczSignature
qrarazDesignation
fYl3::'j
. qfr qr# zd dr$ qftro-rz arar koar A ?il @ H ora s{ftIo'rff +1
-----"*"
qs ftrgrdr
ft6qqe{s6la#-*trszftq<;;n"-tno-ail;*ta'*tsnenBqra-frffi&ss
shoutd stare whether on
:*,n.ffi,.Hfa*ing any compensatory arowance, the san-ctioi-,1.i11*ritv
allowance'
trre expiry oileave rrL-L ut.rv [ ..*r,
thi same post or to anorher post carrying a similar
 gqe +1 efitr EFr rrrd
FORM OF APPLICATTON FOR LEAVE
(srgqro Eqfi 2't 6 tffizSee supplementary Rule 2l6t
ffi: a-< zieqr r i I I r&6 rneff +l &R-dft qrEE qr} qa zr-qqBa d qr erErqqHa r

Note:- Itenl I to l1 Must be filled in by all applicants whether gazzatedor non-gazzated

l. qreff or arar
Name of applicant:
Arol<tT
2. arg # qrffi gqA {M
CCS Leave Rule, 1972 |
Leave rules applicable
3. q<zPost held xP- pw
4, ftanar,o-rqta-q slz srga+rar De-0/i
Depaftment, Olhce and Section D.l. &[q^'*'' ,M
5. trazPay Ltry,,-{- sA
6. o-d-ffrd qq rrz Frd-e ErdT rcFET fr;zrqr
ararrsrqrE aiaTT qr srq gk6rc arA
House rent allowance, conveyance allowance
or other compensatory allowancc drawn in 5 di.t vlt'
the present post,
1. ai?ft a€ gd-A d E;-szsrqftr
si-E srr$ gE # z& an€suNature and
EL ,r L0
period of leave applied tbr and date fi-om which ).8'lo 'L-L1
required.
8. s}z gq& S Bq qtr +tS A,
"fd-{rg
rH ge8 * q-*-&r"-r. # EIB-.-* qrc-i B r

Sundays and holidays. Ifany proposerl to be

prefi xed/suffi xed to leave.
gq.& ol orz"r
9.
Ground on which leave rs applied for. t@4 y*^4,
10. fr'6-S gqe * fu 61 drse
s*z sc{ gq& .bt B-sry aen srqfEr f t, lo'2-rr gt)
Date of return from last leave and the nature
and period ofthat leave.

1l +"rr fa-{rz sndn# gq& 4.....................-:. .........d su-s qfr + fr4-+ gq& lr*r q,t
dfu-o-a ii or B tzl proposed to arail rnyself of leave concession in the block years...........
cluring the ensuing leave.

12. (m) ff E-aa ?-ar { b^3}tl-d aS=r gqatqfrraHa gEA .fi srEf} fr k+ ar+ gq& }d-a s+r
snt i-+a aff gq& i- Era-A qr-& #- d sraz # -sc* z-+-a ErEEr 6-{ qfi-+ g_.e .e
?rilfu q-{ 3rerclT rz{-d a-{rd e} ffi+ra # 6t ft€rft fr gd "nf
1-M. 1 e3 3 +' Be-n r r (ur)(r r r) d drg a ari qz ..g.& a
ts"a 8 r i;) ( r r),benfq-a
(a) I Lrnclcrtakc to rcfund the dilfercnce
ffiz
between the leave salary drawn during the leave on average pay,
cor.nrlrtted leave and that admissible during the leave on behalf average paylialfpay leave,
whicliwould
not have been admissible had thc provision to F.R. 13 (b) (ii) nrle tl
ict iiiil of the i{evised Leave Rules,
1933, not been applied in the event of my retirement fiom service at the end or
during the currency of the
leave.
 AAO,Admin-ll.
Please report Admissibility of Leave.

AAO/

(s) ff EEra -dr d frt et {+6r A ffia-ga € Iaa+q.T * drql q-r ?d a-o qfr i m-a eni
Ba ffi eqa .ff+; #';;*B;;1';'# s-# + oTrg + B a *qrierftia eqa + +sra
qz qF a ma qrff'"t ErA
u-d
tr1-q-a sr(ur)zdeifya trre-arc-fr re3; ;-Eq;-(.T)
ftE*
gd-.A + a.ra 61 Erq-a 6-{ grr I

would not have been admissible had

(b) I undertake to relund the leave salary drawn during "leave not due"which
applied, In the event of my voluntary retirement
F.R. gl (c) Rule 11 (d) of the Revised Leave Rules, 1933 not been
pay leave noi-less than the amount of leave not due availed
or resignation aom seivice at any time until r earn half
ofby nte.

arfi-gr,
I srfr * awTers
Signature ofaPPlicant
Date:

1Q I-aaiqor srRr+r8 d
Remarks attd/or recomflIe 5-sstffiing.
Gcncrat
Dlroctor
olllcer r./D.otl. of Po'l'
bethi-11ooo1

arareruzSignature
qranazDesignation
ar$szDate:

gq& 6f 3rgflr@-in * qrt e q+ITE'rclst

C-ERTIFICATE REG ARDIN G ADMI SSIBILITY OF LEAVE
.==E arfffi * ziqer i a-arlsrerrs Erzr
(By Accountant General In the case of gazzaled officer;

qqrFra En-qr qrm B t ?T6.......... ft-n + ftra

trre-flra-fr srefra ea-A d fu-gn)
srgaw B r

Certitred that.............
is admissible undcr rule-

at=<rerru Signature
q-{arfizDesignation
dr8-s/Date:

. z$effi aa erd sifYenr$ S a{reer

o Order of the Sanctioning authority

atarerzzSignature
qqarazDesignation
arEazDate:

.---#-**;-*€-"**,=;-*-- on*u * ;;*,** ;;B qr "=,* "*"

trF gqe qff 6ra qz sr?lT :-eft
6I
qE
BAar dz
" u-a
ou * m=.n q-" o. ffi zff snen a-fr c-dr gc{
!t5ru- e{cclT
whether on
. lf the applicant is drawing any compensatory ailowance, the sanctioning authority should state
another post carrying a similar allowance'
the expir,v o['1eave he is likely ir..i.,.n the same pott o,. to
 s.R.-1
FOR LEAVE
FOlt APPLIC;\TION
"^-ii".
FORM
^ 216)
SuPPlementarY Rule

in by all applicants whether gazetledor non-gazetted

be filled
Note: Items 1 to 11 must
+nJFtr
1. Name of the aPPlicant
tglL
7. Leave rules aPPlicable

3. Post held *sf'(N\)

gk.lrrq ?Jer, c,il;
and Section '>Y '
4. Department, Ofhce $A
Lt-t-a.+
5. Pay
conveyance
6. House rent aliowance'
comPensatory
allowance or other
the present post'
"-arat$f-
allowances drawn in

7. Nature and period of

leave applied for F L bl.lt,Lo2H)
required
and <iate from which

8. Sunday and holidays' if any

proposed ctuhlrJ)4 e. o3'll't*zi

+*"'""t t*'-+
9. :::ff:i#H:Jo'.,,u.u,",
the
10. Date of retul.rr fi'crn
last leave and
2[.1..2{ (Et)
nature an<l period
of that leave the

IL lproposeclidonotprclposedtoavailmyselfofleavetravelconcesslonln
leave'
during the ensuing
block years ' " " ":- '
12. (a)Ir-rndertaketorefuncthediffrr:noebetweenthelear,esalarydrawnduring
leaveonaveragepay/commutedleavean<ltlratadmissibieleaveonhalfaverage
payhalfleave,whichwouldnothavebeenadmissiblehadtheprovisionto
F.R'81(bXIi)Rule1l(c)(lll)oftherevisedLeaveRules,lg33notbeenappliedin
theeventofmyretiretnentfromserviceatendorduringthecurrencyoftheleave.
t2. (b)Iundertaketorefundleavesalarydrawnduringleavenotduewhichwouldnot
havebeenadmissiblehadF.R.8l(c)Rule11(d)oftheRevisedLeaveRulel933
notbeenapplied,intheeventofmyvoluntaryretirementorresignationfrom
serviceatanytimelurrtilearnhalfpayleavenotlessthantheamountofleavenot
due availed of bY me'
Signature of applicant " " " "
"
Date. qg.t !t':'*'\
 - - Lr

r3. Remarks and-or recommendation of the

controlling Officer.

Dare .*htr't
{61-flmvt

CERTIFICATE REGARDING ADMISSIBILTY OF LEAVE

: (By Accountant General to the case of gazetted Officers)

14. Certified that . ...... [Nature of leave]

for .. . ...... from fperiod] ... . to
is admissible under rule .. , of the Rules.

Signature
Date Designation .....

I the applicant is drawing any compensatory allowance the sanctioning authority

should state whether on the expiry of leave he is likely to return the same post or
to another post carrying a similar allowance.

6gq-[6o1ouq:a1 -iloz / 6 / 9's- I

,zo?./rt890l/l