Title Page
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Conducted on
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Prepared by
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Date
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Employee number
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Name and Surname
Leave type
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How many days of this type of leave do you have left for the year?
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What type of leave are you applying for?
- Annual
- Sick
- Unpaid
- Family Responsibility
- Maternity
- Paternity
- Unpaid
- Study
- Union
- Injury on Duty
- Compasionate
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Date of Joining the Company
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Balance from previous year brought forward
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How many days do you have in lue of this type of leave
Period required
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From:
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To
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Both days inclusive
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Number of working days (Excluding weekends wnd Public Holidays)
Contact information during Absence
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Add location
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Telephone number where you can be reached
Request for Approval
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Signature of Aplicant
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Endorsed by Direct Supervisor
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Approved by Manager
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Select date