Professional Documents
Culture Documents
EMPLOYMENT ABROAD/WITHIN THE COUNTRY/ACCOMPANY SPOUSE ABROAD WITHIN THE COUNTRY ARE
FORWARDED TO GOVERNMENT
______________________ ___________________________________
Signature of Head of Office Counter signature by Sanctioning Authority
(Page 2 of 12)
CHECK LIST
2. Date of birth :
4. Date of retirement :
6. Purpose of leave :
16. Remarks :
______________________ ___________________________________
Signature of Head of Office Counter signature by Sanctioning Authority
(Page 3 of 12)
DECLARATION
DECLARATION
3. It is also declared that I will not entertain in any propaganda which is against
the Government of India.
4. I will return to duty as and when the Government of Kerala call for me back.
5. I also undertake that I will abide by all conditions regarding the sanction of
leave now applied for.
Counter Signature by
Sanctioning Authority
(Page 5 of 12)
DECLARATION
I, …………………………………………, ……………….…………………………………..(designation)
do hereby declare that I have not been convicted by any court of Law for any
offence including moral turpitude.
DECLARATION
DECLARAION
DECLARATION
I, …………………………………………, ……………………………………………………..(designation)
………………………………...……..……..……….(office) do hereby declare that I am fully
aware of the fact that the leave without allowances now applied for if granted
will not be counted for any service benefits including pension and will be
recorded as such in the service book. It is also declare that I am prepared to
abide by all terms and conditions in Appendix XIIA Part I KSR.
DECLARAITON
I, …………………………………………………………, …………………………………..(designation)
………………………………...……..……..……….(office) do hereby declare that I will abide
by the Rules in Appendix XII A of G.O.(P) No 953/86/Fin Dated: 27/12/1986 and
its subsequent amendments.
DECLARATION
I, …………………………………………………………, …………………………………..(designation)
………………………………...……..……..……….(office) do hereby declare that I will abide
the conditions laid down in Appendix XII Part I KSR.
CERTIFICATE
Place: _________________
Date : _________________
1. Name of Applicant :
2. Date of birth :
3. Post held :
4. Department, Office, section :
5. Pay and scale of pay :
6. Date of entry in service :
7. Date of commencement of continuous service :
8. Whether applicant has got confirmation if any post if
so from which date and which post :
9. Address during leave :