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Paternity, Maternity Leave Application Form, Doctor Certificate, affidavit all related Useful Proformas and Govt Orders

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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

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👉 Maternity Leave Application Form, Doctor Certificate Affidavit and all related useful Forms at one place Click below to download

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