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AR/QP04/02

Biomedical Services

Annual Leave Request Form

Project/Site:

Date of Request

Name

Position
From: / /
Dates of Leave Requested
To : / /
Departure Date from Work

Return to Work Date / Time

Total Number of Leave Days

Number of Leave Days Left

Any Clash Yes  No 


If yes, the following arrangement is done.

Signature of the Employee ……………………………………….

Authorized by…………………………… Signature………………………..

Administration Use only No. of days ……………… Hours …………………..

Leave accrued…………….. Leave utilized…………

Approved ………………………..

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