BRAC University Maternity/Paternity Leave application Form

(1)

To ……….. Date ……….

Applicant’s Name ……… PIN ………..

Confirmed / Non Confirmed Staff. If confirmed, Date of Confirmation ………

I, seek approval for leave from……….to …………for a total of……….days (with pay/with out pay) Applicant’s Number of children at present ………….

Details of previous Maternity/Paternity leave, if any:

(1)……….from ……… for a total of…………days (with pay/with out pay)

(2)……….from ……… for a total of…………days (with pay/with out pay) ……….

Applicant’s Signature

Address during Leave Designation………..

_____________________ Department/Section……….

_____________________

………Days leave approved (with pay/without pay) ……….

Authorized Signature

Designation………..

Extension of Leave

Details of leave approved previously:………from………days(with pay/with out pay)

I, seek approval for extension of leave from……….to …………for a total of……….days (with pay/

With out pay)

………Days leave approved (with pay/without pay) ……….

Authorized Signature

Designation………..

Joining date as per leave ………..

Actual joining date ………

__________________ _________________

Applicant’s Signature Authorized Signature