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Special Leave Application

A special leave application covers leave granted at management's discretion for situations outside regular leave categories, such as appearing as a witness in court, representing the state in sports, blood or organ donation, civic duty or disaster relief. It records the purpose, supporting proof and whether the leave is paid.

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[Company Logo][Company Name]

SPECIAL LEAVE APPLICATION FORM

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

A. Employee Details

Employee Name	[Employee Name]
Employee ID	[Employee ID]
Designation	[Designation]
Department	[Department]

B. Category of Special Leave

[ ] Court appearance as witness / summons
[ ] Representing district / state / country in sports or cultural event
[ ] Blood, platelet or organ donation
[ ] Disaster relief or civic volunteering
[ ] Other (specify)	[Details]

C. Leave Details

From [DD/MM/YYYY] To [DD/MM/YYYY] – [Number] days
Purpose in brief
Supporting document attached	[Name of Document]
Special leave availed earlier this year	[Number] days

Declaration: I confirm that the above information is correct and that the leave will be used only for the stated purpose. I will submit proof of attendance or participation on return.

Employee
[Employee Name]
Date: [Date]

D. Recommendation and Sanction

Decision Point	Entry
Recommended by manager	[Yes / No]
Category permitted under policy	[Yes / No]
Sanctioned days	[Number]
Pay status	[Paid / Unpaid]
Debited from regular leave	[No / Yes – Leave Type]
Proof of attendance received on return	[Yes / Pending]

Reporting Manager
[Reporting Manager]
Date: [Date]

Sanctioning Authority
[Authorised Signatory]
Date: [Date]

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What this template includes

Category of special leave as listed in the policy
Supporting document (summons, selection letter, donation certificate)
Paid or unpaid status as decided by the sanctioning authority
Whether the leave affects regular leave balances
Higher-level sanction because it is discretionary
Record for consistency in future decisions

When to use it

Summons to appear as a witness or for a court proceeding
Selection to represent the district, state or country in sports or cultural events
Blood, platelet or organ donation and recovery
Volunteering in disaster relief or civic duty as per company policy

How to customise this template

1Edit the category list to match the special leave provisions in your policy
2Name the authority who can sanction special leave
3Add a cap per year if your policy has one
4Include a CSR volunteering option if relevant

HR tips

Keep a log of special leave decisions so similar cases are treated alike
Ask for proof proportionate to the request
Do not use special leave to bypass regular leave rules for favoured employees
For voting days, check the paid holiday rules applicable in your state for elections

For HR & hiring managers

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Frequently asked questions

What is special leave?+

Special leave is discretionary leave granted for situations not covered by regular leave types, as defined in company policy. It may be paid or unpaid.

Is special leave counted in my leave balance?+

Usually not; it is recorded separately. The sanction should state whether it affects any balance.

Do I need proof for special leave?+

Generally yes, for example the court summons, selection letter or donation certificate, because the leave is granted for a specific purpose.

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
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[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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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]

[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].

Form · Word

Privilege 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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Special Leave Application

Preview of the form

A. Employee Details

B. Category of Special Leave

C. Leave Details

D. Recommendation and Sanction

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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