DIBRUGARH UNIVERSITY
DIBRUGARH
LEAVE APPLICATION FORM FOR TEACHERS/OFFICERS
To
The Vice-Chancellor/Registrar
Dibrugarh University
Dibrugarh
(Through the HoD, Department of _________________________________________________, D.U)
Sir,
I have the honour to request you kindly to grant me leave as stated below:
1. Name :
2. Designation :
3. Department :
4. Nature of leave :
5. Reason for leave :___________________________________________________________________
:___________________________________________________________________
:___________________________________________________________________
6. Duration of leave : From _______________ to _______________
7. No. of days :
8. Arrangement of classes(for teachers) : Yes / No
9. Proposed Incharge(in case of Head / Chairperson / Officers): ___________________________________
Yours faithfully
Date: Signature of the applicant
RECOMMENDATION
1. Recommendation : Yes / No
Date: Head
OFFICIAL USE
1. Details of leave already availed during the year 20........
a) Duty Leave :
b) Special Casual Leave :
c) Casual Leave :
d) Earned Leave :
e) Academic Leave :
Date: Leave granted / Not granted
Vice-Chancellor/Registrar
