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DISCIPLINARY LEAVE FORM

Date: __________

Name of Employee :_________________________________________________

Position :_________________________________________________

Number of Days :_________________________________________________

From (Date) : _________________ to (Date): ___________________

Company Comments:

***Check one or more options below and print total number of days besides it. Example: If you
are requesting leave for 4 hours put 0.5 days as leave request.

Unpaid Leave Days

Admin Executive Signature ESUPPORTKPA Signature

www.akvarr.com | D/101, Kadamgiri Complex, Hanuman Road, Vile Parle (East), Mumbai 400057
O: 1-800-952-5921 | F: 240-396-5769 | E: indiainfo@akvarr.com

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