P.L Form

GOVERNMENT OF RAJASTHAN

FORM OF APPLICATION FOR LEAVE UNDER THE RAJASTHAN SERVICE

RULES

1.                Name of applicant and father’s/  husband name :-                                                                          

2.                Post held :-

3.                Department, Office and Section :-

4.                Pay :-

5.                House rent allowance, Conveyance allowance or other compensatory allowance drawn on the present post

6.                Nature and period of leave applied for and date from which required :-

7.                Sunday and holidays, of any, proposed to be prefixed / surfixed to leave

8.                Ground on which leave is applied for

9.                Date of return form last leave and nature and period of that leave :-

10(a) I undertake to refund the difference between the leave salary drawn during privilage leave commuted leave and that admissible during half-pay leave which would not have been admissible, had the provisions of proviso below clause (iii) of sub rule (c) of rule (2) of Rajasthan Service Rules not been applied in the event of my retirement from service at the end or during the currency of the leave.

(b) I undertake to refund the leave salay drawn during “leave not due” which would not have been admissible had rule 93 (d) of the Rajasthan Service Rules not been applied, in the even of my voluntary retirement from service at the end or during the current of the leave.

11. Leave – Address

Signature of applicant (with date)

12. Remark and/or recommendation of the controlling officer.

Signature/Designation

Certificate Regarding Admissibility of Leave by Accounts General in case of Gazetted Officers.

13.  Certified that ……………………….for ……………………………………………

From …………….. to …………………. is admissible under rule of the Rajasthan Service Rules…………. P.L. is in his credit.

14.  Order of the sanctioning authority.

(Signature/Designation)