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www.sahayam.in
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Form No. 13
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APPLICATION FOR LEAVE
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(Rule 113, Part 1)
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Note : Items 1 to 16 must be filled in by all applicants whether Gazetted or Non-gazetted
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1Name of applicant:
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2Date of Birth:
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3Post held :
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4Department, Office and Section:
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5Pay and Scale of Pay:
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6Date of entry into Service:
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Date of Commencement of continuous service
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8Whether the applicant has got confirmation in any
post, if so from which date and in which post		:
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9Address during leave:
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10House rent allowance, conveyance allowance or other compensatory allowance drawn in the the present post:
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11Nature and period of leave applied for and date from which required:
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12Sundays and holdidays, if any, proposed to be prefixed / suffixed to leave:
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13Ground on which leave is applied for :
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14Date of return from last leave and the nature and period of that leave:
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15(a)
I undertake to refund the difference between the leave salary drawn during commutted leave and that admissible during half pay leave which would not have been admissible in the event of my retirement from service at the end of or during the course of leave
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15(b)
I undertake to refund the leave salary drawn during 'leave not due' which would not have been admissible had rule 85, Part I, not been applied in the event of my voluntary retirement or resignation from service at any time until I earn half pay leave not less than the amount of leave not due availed of by me.
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16Place:
Signature of applicant (with date)
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www.sahayam.in
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Page 2
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17Remarks and or recommendation of the controlling Officer
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Signature (with date) and designation
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Note:
 In the case of a Government servant who is mentally unsound and or physically unable to fill in the columns of this form and sign it, the guardian of his appointed under the Indian Lunacy Act, 1912 (Central Act IV of 1912) or any person authorised by the authority competent to grant the leave may fill in the columns and sign the application for and on behalf of the Government servant.
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Certificate Regarding Admissibilility of Leave
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(By Accountant General in the case of Gazetted Officers)
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"Certified that ………………………………………………...………………………………………(nature of leave) for
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………………………………………………………………….. From…………………………………….…to ………………………………….
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……………………………………………………..is admissible under Rule …………………………………………………………….
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of the Kerala Service Rules.
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Signature (with date) and designation
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19Order of the Sanctioning Authority
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Signature (with date) and designation
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* If the applicant is drawing any compensatory allowance the sanctioning authority should state whether on the expiry of leave he is likely to return to the same post or to another post carrying a similar allowance.
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