Document text
[Date]
To
[Manager name and designation]
[Company name], [City]
Subject: Application for [Type of leave] from [From date] to [To date]
Respected Sir/Madam,
I, [Your name], working as [Designation and department], request you to kindly grant me [Type of leave] for [Number of days] days, from [From date] to [To date] (both days inclusive), because [Reason].
I request that this leave be adjusted against my leave balance. [Enclosure]
Before going on leave I will hand over my pending work to [Colleague]. I will be reachable on [Phone] for anything urgent.
I shall be grateful for your kind approval.
Thanking you,
[Your name]
Received by: ______________________ Date: ____________
For you: not part of the letter, remove this page
– We found no government form: this is a letter to your manager or HR. Check your company’s leave rules first.
– Do not write more about your illness than you need to. A short reason is enough.
– Earned leave: OSH Code 2020, s.32, gives one day for every 20 days worked, once you have worked 180 days in the year. You can carry forward up to 30 days.
– State laws differ and have not been repealed: Maharashtra counts 240 days, Delhi gives 15 days of privileged leave and 12 of casual leave. So there is no single number for all of India.
– If your employer refuses leave you asked for, the refused days carry forward without a limit (s.32).
– ESI members: a letter to your employer does not get you the sickness benefit. Take the certificate from the ESI insurance medical officer to your ESIC branch within 3 days, or you can lose days of pay.
– ESI sickness benefit: about 70% of wages, up to 91 days in two benefit periods. The first 2 days are usually not paid.
– The ESI rules are being replaced in 2026, so form numbers are left out here. Ask your branch.
– Keep a copy of this letter with its date, your employer’s reply and every certificate.
Source: OSH Code 2020, s.32; Code on Social Security 2020; ESI (Central) Rules, r.22; ESI (General) Regulations 1950, reg.53–64 (unofficial copy); state acts of Maharashtra and Delhi. esic.gov.in did not open, read from archive. Checked 02.11.2026. Not legal advice.