AMENDED

Printed by Government Printers, Harare Second Schedule (Section 34 ) 60130-9

‘AMMENDED’ APPLICATION FOR LEAVE

1. An amended Leave Form must be clearly marked ---either “AMENDED/CANCELLED. ORIGINAL DATES WERE 02/05//12
TO 29/06/12
Original to: Manager. Salary Service Bureau. P.O.Box CY 507, Causeway.
2. For all sick-leave in excess of three consecutive working days (six consecutive days in certain areas; and all sick- leave in the uniformed forces; excluding Prisons Services who have
conditions aligned to Public Service). A certificate in the form shown overleaf is required. (Indicate clearly in the “To ” column if indefinite.)
3. Applications for advances of salary must reach Salary Service Bureau at least six weeks prior to start of leave. Unless arrangements have been made to the contrary.
4. An advance of salary may be applied for : (a) in the case of Group 11 or 111 employee, if at least ten days’ leave is taken; (b) in the case of an office or a Group 1 employee, if at
leave 21 days’ leave is taken over a period which includes a pay day.
5. Urgent Private Affairs leave ---for use by Teachers and Defence Forces only.

1. Surname 2. First Names

3 Dept. & Stn. Codes No 4. Ministry/Department 5 Station

APPLICANT TO COMPLETE BELOW: EMPLOYEE CODE NUMBER AND CHECK DIGIT, AND PERIOD OF LEAVE ONLY.
(IF E.C No. AND/OR CHECK DIGIT ARE INCORRECT, FORM WILL BE REJECTED.)

TYPE SECTION SUB SEC EMPLOYEE CODE NUMBER C/D +/- S.S.B USE ONLY
O.P

3 5
1 2 3 4 5 6 8 13 14
15 16 19
Enter ‘O’ for
TYPE OF LEAVE (Enter date as 6 digits: e.g.. 1st JUNE 1979 = 010679) reversal of
Previous entry
20
FROM TO +/- DAYS

21 26 27 32 33 34 36
+/- DAYS

1
VACATION
37 42 43 48 49 50 52

ANNUAL

69 74 75 80

MARTENITY
81 86 87 92

WITHOUT PAY

93 98 99 104

URGENT PRIVATE
AFFAIRS
(Note 6) 93 98 99 104
+/- TERMS

SCHOOL (Teachers)

105 110 111 116 117 118 120

ADVANCE OF SALARY
If required insert ‘Y ‘in Box 121 121

(Notes 4 & 5) If Yes. State number of months .

from the month of ..200 .to .200 ..

Nursing staff. Ministry Of Health:

and Members Of the Z.R. Police. I certify that I will be vacating Government accommodation
Prisons. Service and Air Force
from N/A to .(inclusive)

Address whilst

Signature of applicant Recommended Approved

 AMENDED
.. .. .
Date Date .. Date

FIRST SHCEDULE (Sections 19 and 23)

CERTIFICATE FOR SICK- LEAVE
PART 1

I certify that has been under my medical/dental

(Name of applicant)
treatment for a period from to .
(actual dates)

and that his/her illness prevented him/her attending to his/her duties during the period .

to ...and was not occasioned by misconduct or failure to take reasoned precautions;

(Actual dates)
and I consider him/her to be unfit to discharge his/her duties and that it is necessary and indispensable for the recovery

of his/her health that he/she should have leave until for the purpose of
(state date)
...

...

Signature of Registered Medical Practitioner or Dental

Practitioner

...
Name in block letters of Registered Medical Practitioner
or Dental Practitioner

Date Qualifications

Note.—Sick-leave in excess of 90 days in the case of an officer or employee can be granted only on the recommendation
of a medical board.

PART 11

NOTIFICATION OF ABSENCE DUE TO INJURY OR ILLNESS

Note.—To be forwarded to the establishment officer of the department WITHIN 14 DAYS when absence from duty
will be longer than 14 days or the exact duration of sick-leave cannot be determined.

I certify that ..has been under my medical/dental treatment from

and that owing to illness is unable to attend to his/her duties until

further notice

. .
Signature of Registered Medical Practitioner or Dental
Practitioner

...
 AMENDED
Name in block letters of Registered Medical Practitioner
or Dental Practitioner

Date Qualifications