Leave Request Form – Non Teaching

NAME :
DATE :
DEPARTMENT :
DESIGNATION :
Leave Applied : From To Total number of days
Tick the type of leave applied for: - Casual LeaveShort LeaveComp. Off/ LWP LeaveAcademic LeaveLWP
Reason for Leave:

Duties to be performed in absence by:
(I hereby undertake that I’ll not be on leave during the above mentioned period and will be acting on his/her behalf for the major duties and responsibilities.)
Address when on leave: Phone :

For Compensatory Leave:

Compensatory leave applied for Day: Date:
Compensatory leave availed against:
holiday, Dated
Reason for working on a holiday:
Place of work:
Duration of work :
Recommended by Dept. Head :

UNDERTAKING OF KEY RESPONSIBILITIES

NAME :
DATE :
DEPARTMENT :
DESIGNATION :
Leave Applied : From To
Total number of days :
Duties to be performed in absence by :

I, undertake the following responsibilities on behalf of

1. I have shared my official email details (username & password) with the designated person, so that the business activities are not affected.

2.

3.

4.

5.

6.

I hereby undertake that I’ll not be on leave during the above mentioned period and will be acting on his/her behalf for the major duties and responsibilities.