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APPLICATION FOR PERMISSION TO APPLY FOR EX-INDIA LEAVE /

1. Name, Designation and office in whichWorking:

2. Date of Birth:

3. Date of appointment to the Presentpost:

4. Whether post held on ad-hoc basis orin a regular capacity:

5. If regular, whether temporary orpermanent:

6. Names of countries proposed to bevisited:

7. Purpose of visit:

8. Name of the training/course andduration oftraining/course abroad:

9. The period of earned leave applied foras Ex-India leave:

10. Probable duration of the visit:

11. How the extra expenditure (besidesthe expenditure borne by thesponsoring Department) on the visitabroad will be met:

12. Details of previous private visitsabroad, if any:

UNDERTAKING

I undertake that I will return to India on the expiry of my leave and will not acceptany job or join any course during the period of my stay abroad, failing which I willbe liable to disciplinary action' as required under the Punjab Civil Service(Punishment and Appeal) Rules 1970 for violation of the Government Employees(Conduct) Rules, 1966.Place:

Date:Signature of applicant

Email and Mobile/Contact No.-----------------------

1. Certified that the information furnished above is correct.2. Certified that there is no disciplinary or vigilance case IS

pending/contemplated against the officer. .3. Leave recommended.

Signature & Designation of Controlling Officer

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2.

"A self certification from the offlc~r J official applying for Ex-India Leave

to the effect that he/she or hls/ber family members as a 'family' as has

been defined in the Government employee (Conduct) Rules, 1966, have

neither applled nor someone else has applied for them, nor they have

obtained any foreign citlzenshlp, duaf citizenship, permanent reSidence,

any visa other than tourist visa, or any specIal status that is not

ordinarily available to a cItizen of India. If otherwise, full details with

cartlfJed copies of relevant documents and permls$ioos of the '

competent authority be furnished along with the leave application."

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