Commuted Leave Form printable pdf download

FORM NO. 13

APPLICATION FOR LEAVE

(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

15.

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

16.Place

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.

CERTIFICATE REGARDING ADMISSIBILITY OF LEAVE

(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

Commuted Leave Form

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