Surya Group of Institution

Gaura,Mohanlal Ganj (Raibareily Road) Lucknow -!"#$

CEST/SSPEM/SCBM
LEAVE APPLICATION
NAME OF FACULTY:..............................................
DESIGNATION.DEPARTMENT..
Type of Leave applied for Casual/Medical/Earned /Duty /Other
(Medical /Fitness Certifcate to be enclosed in case of Medical Leave)
DURATION OF LEAVE: From..To..No. of Days..
REASON FOR LEAVE:.....................
CLASS ARRANGEMENT DURING LEAVE FOR FACULTY
S%&o% 'ate (eriod Subject
)ode
Subject *lternati+e
,aculty
Si-nature of
*lternati+e ,aculty
Address during Leave:....
Contact No:.
Date: (Signature of Applicant)
Leave Position as on Date AvailedDue
(Signature)
Recommended by:
(Name Designation)
Date:
Sanctioned/Not sanctioned/Sanctioned without pay
Signature of Sanctioning Authority
Entered in Leave Register on Page No.
Date: