1 Name of the Employee : ______________________________
2 Designation : ______________________________
3 Place of working : ______________________________
4 Date of Increment : ______________________________
5 Period of Surrender of Earned Leave : From ___________ To __________
6 No. of days of E.L. to be Surrendered : 15/30 days
7 Basic Pay & Scale of Pay : ______________________________
8No. of days of Earned Leave surrendered
during last financial year & Month ______________________________
9 Remarks : ______________________________
Signature of the Applicant: Signature of the Head Master
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