RECORD NO.
    APPLICATION FOR LEAVE    
           
           
  Surname & Initials Emp. No. Division Cost Code Date
                 
                   
To: HUMAN RESOURCES DEPARTMENT  
   
PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING FORM
   
1. Once this leave application has been approved, the leave is regarded as official.  
2. In the event of date/s change only, it is the sole responsibility of the applicant to re-submit a leave application 
  showing the corrected dates and also indicating in the cancellation column that the previous date/s is/are cancelled.
3. In the event of entire leave cancelled, re-submit an application form indicating in the cancellation column the  
  previous dates submitted and now cancelled.   
4. The applicant must notify the finance departmentl within 7 days of application of any change of leave dates.   
  If this is not done, adjustment cannot be made.   
5. Sick leave applications must be accompanied by a doctor's certificate if  they are in excess of two days, or if absent
  on Monday or Friday, or if absent the day before or after a public holiday.  
                   
Type of leave Leave  Current Leave Dates Inclusive Leave Applied For Leave Balance
    Code Entitlement From To (Working days)    
Annual                
Sick (Doctors Certificate)              
Study                
Unpaid                
Other/Paternity                
Compassionate              
Maternity                
Cancellation                  
Address and Telephone Number while on leave              
   
   
            Employee Signature …………………………………..
Approved by:         Recorded on leave record    
       
       
…………………………………………………………..      
DIVISIONAL MANAGER              
Remarks                
   
MOMENTUM IT trading as IOCORE Global Resourcing SA  
Registered Number:  3646268  
Vat number: 709 3289 19