Uttar Pradesh Rural Road Development Agency

Department of Rural Development Government of uttar pradesh

Name of Applicant	;
Post Held	;
Department/Office/Section	;
Pay Drawn	;
House Rent and other Compensatory allowances drawn in the present post	;
Nature of leave applied for	;
Period of Leave required	;
Date from which required	;
Saturdays, Sundays & holidays, if any, proposed to be prefixed/suffixed to leave	;
Grounds on which leave is applied for	;
Date of return from last leave and the nature and period of that leave	;
Address: Local	;
Permanent	;
During the leave period	;

I propose/do not propose to avail of LTC for the block years __________ during the ensuing leave.

Remarks/Recommendations of the
Controlling Officer ________________________
(Signature & designation with date)

(Signature of the applicant with date)