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Privilege Leave Application

A privilege leave application is the form employees, often in factories, banks and older establishments, use to apply for PL, the paid annual leave earned through service. It records eligibility, days earned, the period applied for and the sanction, matching the leave-with-wages records.

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[Company Logo][Company Name]

PRIVILEGE LEAVE APPLICATION FORM

Establishment:: [Company Name]
Unit / Plant:: [Work Location]
Application No.:: [Reference Number]
Date:: [Date]

A. Worker / Employee Details

Name	[Employee Name]
Token / Employee No.	[Employee ID]
Department / Section	[Department]
Designation / Grade	[Designation]
Shift	[ ] General [ ] A [ ] B [ ] C
Date of Joining	[Date of Joining]

B. Leave Applied

Period: From [DD/MM/YYYY] To [DD/MM/YYYY]
Number of days	[Number]
Holidays / weekly offs falling within the period	[Dates]
Purpose	[Purpose]
Address during leave	[Address]
Advance wages requested	[ ] Yes [ ] No

I request privilege leave for the above period. I will report for duty in my shift on [DD/MM/YYYY].

Signature / Thumb Impression of Applicant
[Employee Name]
Date: [Date]

C. Time Office Verification

Particulars	Days
Days worked in the previous year	[Number]
PL balance brought forward	[Number]
PL earned for the year	[Number]
PL availed so far this year	[Number]
PL available	[Number]
PL now sanctioned	[Number]
Balance after sanction	[Number]

Time Office
[Name]
Date: [Date]

D. Sanction

Recommended by Supervisor / Section In-charge	[ ] Yes [ ] Reschedule to [Dates]
Sanctioned by HR / Factory Manager	[ ] Yes [ ] No
Entered in leave-with-wages register on	[Date]

Supervisor
[Reporting Manager]

HR / Factory Manager
[Authorised Signatory]

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What this template includes

Token or employee number and shift details for plant workers
Days worked in the previous calendar year for eligibility verification
PL earned, availed and balance
Period applied, with any holidays falling within it
Advance wages request if allowed by policy
Time office and HR sanction

When to use it

Manufacturing units and establishments that use the term "privilege leave" in standing orders
Workers applying for leave with wages earned through days worked
Leave that must be entered in the leave-with-wages register
Applications that need verification of days worked in the previous year

How to customise this template

1Use the token number and shift fields if this is for a plant; remove them for an office
2Align the eligibility section with the rules applicable to your establishment
3Add advance wages section only if your policy provides it
4Translate into the local language for shop-floor workers if needed

HR tips

Verify days worked from the attendance muster before sanction
Plan PL around production schedules but do not deny it repeatedly
Record PL in the leave-with-wages register immediately
Explain the balance to workers who may not read the payslip easily

This template is a starting point only. Review it against applicable labour laws, the relevant state Shops & Establishments or Factories rules, the Labour Codes and their rules as notified, your standing orders and leave policy, and take legal advice where needed.

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Frequently asked questions

Is privilege leave the same as earned leave?+

Yes, in most companies the terms privilege leave, earned leave and annual leave refer to the same paid leave that accrues with service. The name depends on the standing orders or policy.

Who is eligible for privilege leave?+

Eligibility and the rate of accrual depend on the law applicable to the establishment (for example factory or shops rules, and the Labour Codes as notified) and the company policy. Check them for exact thresholds.

Can privilege leave be refused?+

An employer may ask to reschedule PL for operational reasons in line with the applicable rules and policy, but should record reasons and avoid repeated refusals.

All 50 leave management →

[Company Logo][Company Name]

LEAVE APPLICATION FORM

Company:: [Company Name]
Form No.:: [Reference Number]
Date of Application:: [Date]

Part A – Employee Details

Employee Name
Employee ID
Designation
Department
Reporting Manager
Work Location
Mobile Number

Part B – Leave Details

Type of Leave	[ ] Casual [ ] Sick [ ] Earned/Privilege [ ] Compensatory Off [ ] Leave Without Pay [ ] Other: [Specify]
From Date (DD/MM/YYYY)
To Date (DD/MM/YYYY)
Number of Working Days
Half Day	[ ] First Half [ ] Second Half [ ] Not Applicable
Reason for Leave
Address and Phone Number During Leave

Part C – Work Handover

Form · Word

Leave Application Form

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[Company Logo][Company Name]
CASUAL LEAVE APPLICATION
Date:
[Date]
To,
[Reporting Manager]
[Designation]
[Department]
[Company Name], [Work Location]
Subject: Application for Casual Leave on [DD/MM/YYYY] [to DD/MM/YYYY]
Dear Sir / Madam,
I request casual leave for [Number] day(s) on [DD/MM/YYYY] [to DD/MM/YYYY] to attend to [a personal matter / a family function / documentation work at a government office].
I have completed or handed over my pending work as follows:
Letter · Word
Casual Leave Application
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[Company Logo][Company Name]
SICK LEAVE APPLICATION
Date:
[Date]
To,
[Reporting Manager]
[Department]
[Company Name]
Subject: Application for Sick Leave from [DD/MM/YYYY] to [DD/MM/YYYY]
Dear [Reporting Manager],
I was unwell with [fever / viral infection / a medical condition] from [DD/MM/YYYY] and, on the advice of my doctor, was unable to attend office. I had informed you by [phone / message / email] on [DD/MM/YYYY] at [Time].
I request that my absence from [DD/MM/YYYY] to [DD/MM/YYYY], a total of [Number] working days, be treated as sick leave.
Letter · Word
Sick Leave Application
Download .docx
[Company Logo][Company Name]
EARNED LEAVE APPLICATION
Date:
[Date]
To,
[Reporting Manager]
[Designation]
[Company Name]

Through: HR Department
Subject: Application for Earned Leave from [DD/MM/YYYY] to [DD/MM/YYYY]
Dear [Reporting Manager],
I wish to apply for earned leave of [Number] days from [DD/MM/YYYY] to [DD/MM/YYYY] for [a family vacation / a visit to my native place / personal commitments]. I request permission to [prefix / suffix] the holiday / weekly off on [DD/MM/YYYY] to this leave, as permitted under the leave policy.
Particulars Details
Earned leave balance as on date [Number] days
Leave applied [Number] days
Balance after leave [Number] days
Date of rejoining [DD/MM/YYYY]
Letter · Word
Earned Leave Application
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[Company Logo][Company Name]
APPLICATION FOR PAID LEAVE
Date:
[Date]
To,
The HR Department
[Company Name]
[Company Address]

Copy: [Reporting Manager]
Subject: Request for Paid Leave from [DD/MM/YYYY] to [DD/MM/YYYY]
Dear Sir / Madam,
I request paid leave of [Number] working days from [DD/MM/YYYY] to [DD/MM/YYYY] for [personal reasons / travel / family commitments]. As per my latest leave statement, my available paid leave balance is [Number] days.
I request that this leave be processed with full pay for the month of [Month, Year]. In case my balance is found to be insufficient, please:
Letter · Word
Paid Leave Application
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[Company Logo][Company Name]
APPLICATION FOR LEAVE WITHOUT PAY
Date:
[Date]
To,
[Reporting Manager]
[Department], [Company Name]

Copy: HR Department
Subject: Request for Leave Without Pay from [DD/MM/YYYY] to [DD/MM/YYYY]
Dear [Reporting Manager],
I request leave without pay for [Number] days from [DD/MM/YYYY] to [DD/MM/YYYY]. I need this time because [brief reason, e.g. care of a family member / completion of a personal legal matter / relocation of my family].
I have checked my leave balances and confirm that my casual, sick and earned leave are [exhausted / not sufficient for this period]: CL [Number], SL [Number], EL [Number].
Letter · Word
Unpaid Leave Application
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[Company Logo][Company Name]
APPLICATION FOR MATERNITY LEAVE
Date:
[Date]
To,
The HR Manager
[Company Name]
[Company Address]

Copy: [Reporting Manager]
Subject: Application for Maternity Leave
Dear [HR Name],
I am pleased to inform you that I am expecting a child, and my expected date of delivery is [DD/MM/YYYY], as per the enclosed certificate from [Doctor Name / Hospital Name].
I request maternity leave from [DD/MM/YYYY] to [DD/MM/YYYY], a total of [Number] weeks, in accordance with the maternity benefit provisions applicable to me and the company policy. Of this, I propose to take [Number] weeks before the expected date of delivery and the balance after delivery.
Letter · Word
Maternity Leave Application
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[Company Logo][Company Name]
PATERNITY LEAVE APPLICATION
Date:
[Date]
To,
[Reporting Manager]
[Department]
[Company Name]

Copy: HR Department
Subject: Application for Paternity Leave
Dear [Reporting Manager],
My wife / partner, [Spouse Name], is expecting our child, with the expected date of delivery on [DD/MM/YYYY] [/ delivered our child on DD/MM/YYYY]. I request paternity leave of [Number] days as provided under the company's paternity leave policy.
Leave requested: From [DD/MM/YYYY] To [DD/MM/YYYY]
[ ] Single block [ ] Split [Number] days from [DD/MM/YYYY] and [Number] days from [DD/MM/YYYY]
Additional earned leave requested [Number] days / None
Letter · Word
Paternity Leave Application
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