Dr.
Ram Manohar Lohiya National Law University, Lucknow
Leave Application Form
(For Faculty Members/ Officers/ Staff Members)
(Restricted Holiday/Casual Leave/Earn Leave/Half Pay Leave/Commuted Leave/Other Leaves (as mentioned in University Regulation))
1. Applicant’s Name: …………………………………………………………………………...................
2. Designation: ………………………………………………………………………………….................
3. Section / Deptt : …………………………………………………………………………………………
4. Nature of leave: RH CL EL HpL ComL Other Leaves
Please mention the name of leave, in case of other leave: ………………………………………………
5. Leave from ……………....……...to ……………..….………. for .……..………………days
With permission to prefix ………………………………… Suffix ………………………………being
Holiday (s) / Saturday (s) / Sunday (s) (where necessary)
6. Purpose of Leave ……………………………………………………………………………………….
7. Permission to leave headquarters from …………………………………………………………………
Date ………………… Signature of Applicant
Remarks of the forwarding officer
1. Total Restricted Leave (RH): 02 Availed …..……… Balance ……..………..
2. Total Casual Leave: …………… Availed …..……… Balance ……..………..
3. Total Earned Leave: …………… Availed …..……… Balance ……..……….
4. *Total Half Pay Leave: …………… Availed …..……… Balance ……..……….
5. * Total Commuted Leave: …………… Availed …..……… Balance ……..……….
6. Other Leaves: …………… Availed …..……… Balance ……..……….
Signature of the forwarding officer
Remarks of the Sanctioning Authority
Sanctioned / not sanctioned
Date: Signature of the Sanctioning Authority
* Note:- Marked leaves are sanctioned on medical ground only. Applicant is required to support the application with medical
certificate.