Name of the Applicant ………………………………………………………………… Leave rules Applicable ………………………………………………………………… Post held ………………………………………………………………………………… Department, office and section …………………………………………………………. Pay
a) Pay Band ……...
b) Basic Pay ………………
c) Grade Pay ……………………….
HRA or other compensated allowance drawn on present post……………………………. Nature and Period of leave applied: Maternity leave , ………. month…………days Date from which required : from…………to …………………………………….. Sundays and holidays, if any proposed to be prefixed to be suffixed to leave ………….. Ground on which leave is applied for ……………………………………………………. Address during leave periof ……………………………………………………………… Date of return from last leave and the nature and the period of leave. …………………….
a) I undertake to refund the difference between the leave salary drawn during leave on average pay / commuted leave and that admissible during leave on average pay / half pay leave which would not have been admissible and the provision to rule 1873.
b) (ii) Rule 80, 119 (iii) of the Haryana Civil Service Rules Volume I part I not been applied in the event of my retirement from service at the end or during the currency of the leave.
c) I undertake to refund the leave salary drawn during “leave not due” which would not have been admissible, rule 80 73 c) rule, 119.
d) of Haryana Civil Service Rules, Volume 1 part I not been applied in the event of my voluntary retirement or resignation from service any time until earned half pay leave not less than the amount of leave due availed of by me.
Signature of applicant
⏩ * Maternity Leave 180 days Enhanced GO 152 Copy
⏩ * Paternity Leave Avail either before 15days or within 6 months Copy
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⏩ New AP GO 132 Child Care Leave 60 days to AP women Employees Copy
👉 Maternity Leave Application Form, Doctor Certificate Affidavit and all related useful Forms at one place Click below to download
👉 Paternity Leave Govt Order Copy
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