Commuted Leave Form


(Rule 113. Part 1)
Note:Items 1 to 16 must be fille in by all applicants wheather Gezetted or non- Gezetted
1.Name of applicant
2.Date of birth
3.Post held
4.Department office and section
5.Pay and scale of Pay
6.Date of entry in service
7.Date of commencement of continous service
8.Whether the applicant has got confirmation in any
post if so from which date and which post
9.Address during the leave
10.House rent allowance,Conveyance Allowance
or other Compensatory Allowance drawn in the
present post
11.Nature and periods of leave applied for and
date from which required
12.Sundays and holidays,if any,proposed to be
prefixed/suffixed to leave
13.Ground on which leave is applied for
14.Date of return from last leave and the nature and
period of that leave
a) I under take to refund the difference between the leave salary drawn during commuted leave and that admissible
during half pay leave which would not have been admissible in the event of any retirement from service at the end of
during the currency of leave
b)I under take to refund the leave salary during ‘leave not due’which would not have been admission bad rule85,part 1
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 or leave not due availed of by me
Signature of the applicant (with date) date
17.Remarks and/or recommendations of the controlling officer
Signature(with date ) and designation
Note:In the case of government servent who is mentally unsoundand/or physically unable to fill the columns of this form
and sign it the guardian of his appointed under the Indian Lunancy act 1912(central act iv of 1912)or any persion
authorized by the authoprity competent authority leave may fill in the column and sign application for and on behalf of
the Government servent.
(By accountant general in the case of Gezetted officers)
18.Certified that……………………………………………….(Nature of leave), For………………
from…………to……….Is admissible under rule………of the Kerala Service rules.
Signature (with date)designation
19.Orders of the sanctioning authority:
Signature (with date)designation


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