1. HARYANA VIDYUT PRASARAN NIGAM
APPLICATION FOR MEDICAL LEAVE OF _________________________
Name of official Period and nature of leave applied Last Recommendation of
and the for and the article of the C.S.R. or leave Officer
appointment he the Fundamental rules under which enjoyed
holds claimed
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Purpose of leave :- ______________
Address while on leave :- _______________________________
________________________________
_________________________________
Signature of Applicant
Certified that ___________days _____________leave is due to
Sh.______________________under rule 8.119(C) of CSR Vol.1 Part-1 as per balance in his

2. S/Book. The entry of this application alongwith its particular has been entered in the leave
verification register Sr. No. ________ Page No._______.
Auditor S.O. /EAD