Application Details
Form of Application for Leave
(See Supplementary Rule 216)
Note: Items 1 to 11 must be filled in by the applicant whether Gazetted or Non-Gazetted.
1.
Name of Applicant
2.
Post held
3.
Department / Office
/
4.
Pay
5.
House rent allowance, conveyance allowance or other compensatory allowance drawn in the present post
6.
Nature and period of leave applied for and date from which required
Earned Leave -
7.
Grounds on which leave is applied for
8.
Date of return from last leave and the nature and period of that leave
-
9.
I propose / do not propose to avail myself of leave travel concession in the block years during the ensuing leave
No
10.
Address during leave period
Date: 05/03/2026
Signature of Applicant
Certificate regarding admissibility of leave
11. Certified that Earned Leave for is admissible under rule _______________ of the Haryana Civil Services (Leave) Rules, 2016.
Signature (with date)
Designation