LEAVE APPLICATION FORM

Date:

Employee Name:

Employee Code:

Department:

Number of days of leave requested for

Number of Days:

From:

To:

If half day

Morning:

Afternoon:

Reason for requesting leave:

Contact Address during leave period:

Phone Number:

Signature of Employee and Date:

Leave sanctioned as follows (To be filled in by Supervisor) No leave sanctioned: Reason for not sanctioning leave:

Supervisors Signature and Date Department Heads Signature and Date

Leave adjusted against Balance (For HR and Finance)

Leave without pay (to be adjusted in payroll):

Human Resource Representative and date Finance Representative and date (if LWP)