ALLI

NDI
AINSTI
TUTEOFMEDI
CALSCI
ENCES,
NEW DELHI

Appl
i
cat
ionFormforGrantofLeav
e
(
Thr
oughProperChannels)
EARNEDLEAVE

1.Nameoft
heappl
i
cant - _
___
__Anushka
_
___
______Agrawal
__
________
___
___

2.Desi
gnat
ionandDepar
tment Junior
- Resident,
_______
_ _ Department
_
____
__ _
_____of
__ Anaesthesiology
__
______

3.Numberofday
sandper
iodofl
eav
e - _
_2_
_days
_____(23-24
_______October,2024)
__
______________
___
r
equi
red

4.Nat
ure/
typeofl
eav
erequi
red - _
___
_Earned
______
_ leave
_____
_ _
___
___
___
___
___
_

5.Reasonf
orgr
antofl
eav
eappl
i
edf
or- _
___
___
_Personal
_______
__ _
___
___
___
___
___
__

6.Whetherpermissi
oni
sal
soneededt
o-_
___
___
_No
_
___
___
___
___
___
___
___
___
__
l
eavethestati
on

7.Resi
dent
ial
addressorcont
act- _
_Landmark
_____
_____Apartments,
__
___ _
______ Vipin
_
___ __Garden
__
___
det
ail
sdur
ingleaveper
iod
_
_Uttam
______Nagar
_
______East
__
___ _
___
___
___
___
__

_
__Contact
__
______ no:
__
__ 9310372695
___
______
_____
___
___

__
___
_____
____
_ _
_____
___
___
Dat
ed:
__21/10/2024
___________ Si
gnat
ureoftheappl
icant
Name&designation:

Noted
Dr Anjalee

__
____
_ _
_____
_ _
___
___
____
_ _
___
___
___
___
___
___
_
Si
gnatureoftheHeadoftheDept
.