Commuted Leave Application Form

Form No. 13
APPLICATION FOR LEAVE
(Rule 113, Part 1)

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 continuous service
8.Whether the applicant has got confirmation in any post, if so from which date and in which post
9.Address during leave
10.House rent allowance, conveyance allowance or other compensatory allowance drawn in the present post
11.Nature and period 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)
b)
16.Place
Signature of applicant (with date)

I undertake 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 my retirement from service at the end of or during the course of leave.

I undertake to refund the leave salary drawn during 'leave not due' which would not have been admissible had rule 85, Part I, 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 of leave not due availed of by me.

Note: Items 1 to 16 must be filled in by all applicants whether Gazetted or Non-gazetted.

To be filled by office:
17.Signature (with date) and designation
18.Orders of the sanctioning authority
19.Remarks and/or recommendation of the controlling officer
Signature (with date) and Designation

* If the applicant is drawing any compensatory allowance the sanctioning authority should state whether on the expiry of leave he is likely to return to the same post or to another post carrying a similar allowance.

Certificate Regarding Admissibility of Leave
(By Accountant General in the case of Gazetted Officers)

Certified that for from to is admissible under rule of the Kerala Service Rules.