CENTRAL BOARD OF SECONDARY EDUCATION
SHIKSHA KENDRA, 2, COMMUNITY CENTRE,
PREET VIHAR, DELHI – 110 092

APPLICATION FORM FOR LEAVE / EXTENSION OF LEAVE

1. Name of the Applicant			____________________________________
    (in Block Letters)
2. Designation					____________________________________

3. Branch / Section				____________________________________

4. Nature of leave				____________________________________

    PERIOD OF LEAVE APPLIED FOR FROM___________TO__________(DAYS)_________

5. Ground on which leave applied for		____________________________________

6. Date of return from last leave		____________________________________
    (other than the casual leave)

7. Whether propose/do not propose to avail
    LTC during the leave applied for. If so,
    Block year be indicated			____________________________________

8. Home address/Leave period address	____________________________________
						
						____________________________________

						____________________________________
Dated__________

							Signature_____________________

RECOMMENDATION OF THE BRANCH INCHARGE

SIGNATURE----------------------------
NAME------------------------------------
 DESIGNATION------------------------
DATE-----------------------------------

Forwarded to:
Section Officer (Admn.I/II)