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Klinik Rafi Ahmad Sdn Bhd

No 11,Jalan Kelicap,Pekan Baru,


34200 Parit Buntar,Perak.

Leave application form


Leave Information

Employee Name:

Type of Absence Requested:

Sick Vacation Bereavement Time Off Without Pay

Maternity Others

Date(s) of Absence: From: To:

Reason for Absence:

You must submit requests for absences, other than sick leave and emergency leave, three days prior to the first day you will
be absent.

Employee Signature Date

Dr Rafi Ahmad Abd Muthalip


MBBS (Madras)
Klinik Rafi Ahmad Sdn Bhd

Approved

Rejected

Comments:

Klinik Rafi Ahmad Sdn Bhd (185261A)

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