This document details various forms and schedules related to leave procedures for government servants under the Central Civil Services (Leave) Rules, 1972. It covers applications for leave, leave accounts, medical certificates for different situations (gazetted and non-gazetted officers), and bonds for temporary and permanent employees proceeding on study leave or extraordinary leave. The forms outline requirements for documenting leave details, medical assessments, and financial obligations related to leave conditions. It specifies procedures for different types of leave including special disability leave, study leave, and commuted leave, and provides guidance on leave travel concession and refund of leave salary in case of resignation.
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Note 2: If the Government servant is serving with a State Government, by the State Government or by such authority as may be specified by that Government.
- Special Disability Leave.
- (i) Ministry/Department of the Central Government.
- (ii) Administrator.
- (iii) Comptroller and Auditor-General.
- (iv) Head of Department.
- (v) Any other authority which is the appointing authority.
- Study Leave.
- (i) Ministry/Department of the Central Government.
- (ii) Administrator.
- (iii) Comptroller and Auditor-General.
THE SECOND SCHEDULE
[See rule 3(h)]
FORM 1
(See rule 14)
Application for Leave or for Extension of Leave
- Name of applicant.
- Post held.
- Department, Office and Section.
- Pay.
- House rent and other compensatory allowances drawn in the present post.
- Nature and period of leave applied for and date from which required.
- Sundays and holidays, if any, proposed to be prefixed/suffixed to leave.
- Grounds on which leave is applied for.
- Date of return from last leave, and the nature and period of that leave.
- I propose/do not propose to avail myself of leave travel concession for the block years during the ensuing leave.
- Address during leave period.
*12. In the event of my resignation or voluntary retirement from service, I undertake to refund:—
(i) the difference between the leave salary drawn during ‘commuted leave’ and that admissible during half-pay leave, which would not have been admissible had sub-rule (1) of rule 30 not been applied.
(ii) the leave salary drawn during ‘leave not due’ which would not have been admissible had sub-rule (1) of rule 31 not been applied.
- (Score out whatever be not applicable).
Signature of Applicant (with date)
- Remarks and/or recommendation of the Controlling Officer.
Signature (with date)
Designation
Certificate regarding Admissibility of Leave
(By Audit Officer in case of Gazetted Officer)
- Certified that …………………………………………… (nature of leave)
for …………………………………………… (period)
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| Date of birth | Date of compulsory retirement | Half pay leave (on private affairs and …) |
|---|---|---|
| Length of service | Credit of leave | Leave taken |
| from | to | No. of completed years |
| 10 | 11 | 12 |
| — | — | — |
| from | to | No. of days |
| 18 | 19 | 20 |
| taken | Total Half pay leave taken (Columns 17+21+25) | Balance on return from leave (columns 14-29) | Other kinds of leave taken |
|---|---|---|---|
| entire service | Total of leave not due (columns 24+27) | ||
| Otherwise than on Medical Certificate limits to 180 days | |||
| from | to | No. of days | |
| 25 | 26 | 27 | 28 |
Note 1:— Period of extraordinary leave taken should be noted in red ink in column 31.
Note 2:— The entries in columns 10 and 11 should indicate only the beginning and end of completed year of service; the time the half pay leave commences. Where a Government servant completes another year of service while on half pay leave, the extra credit should be shown in columns 10 to 14 by making suitable additional entries and this should be taken into account when completing column 30.
Note 3:— When a Government servant is transferred from service to any place outside India, a separate subsidiary leave account should be opened in this Form in order to find out the amount of leave earned in respect of such service for the purpose of exemption of the leave salary drawn outside India for the recovery of income tax at source.
Form 3
(See rule 18)
Medical Certificate for Gazetted Officers recommended leave or Extension of leave or communication of leave.
(a) If the Government servant is not stationed in a place covered by the Central Government Health Scheme.
Statement of the case of …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
certified copies thereof) on which leave was granted or extended and have taken these into consideration in arriving at out/my decision.
Member of Medical Board
(1) …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………..