(Ad. G. Form)

[See para (16) of the Instructions in Appendix ‘A’ at the end of part III]

Leave Salary Certificate for leave salary payable at the Home Treasury

Leave salary certificate of ______________________________ of the ______________________________ proceeding on ______________________________ to ______________________________.

1. Government under which employed


2. Substantive post


3. Officiating post (if any)


4. Statement of present leave


Nature of leave (specifying periods on average pay, half average pay and quarter average pay separately)






Monthly rate of leave salary (and allowances, if any) subject to the deductions noted on the reverse

Article and clause of the Fundamental Rules or other Regulations


5. Place of payment


6. Date from which first payment is to be made


7. Amount (if any) paid in advance


8. Government and head of account to which the payment is debitable





9. Date of leaving India



10. Date on which the government servant, will during the currency of leave, complete the term of service or attain the age after which by any rule he is required to retire from the service as for instance 58 years of age.



11. Period for and terms on which leave may be extended, or commuted otherwise than on extraordinary leave.





may be extended on medical certificate


without medical certificate on same leave-salary by


(Further particulars required in the case of military officers in civil employ).

12. Date of commencement of pension service





13. Date of entry under civil leave rules



14. Amount of leave at credit at commencement of present leave


Earned in respect of service under military rules. Earned in respect of service while under civil rules.


15. Date of being struck off duty



16. Deductions to be made



Indian Civil Service Family Military or Indian Military Widows and Orphans Fund or Superior Services (India) Family Pension Fund subscription.

for Wife

Rates per mensem from



„ sons „

„ „


„ daughters „

„ „


A balance of donation on and interest * is recoverable at a month from __________



*In cases of subscribers to Indian Civil Service Family Pension and Superior Service (India) Family Pension Fund interest accrued in India to be given here.


M. C.

Medical Certificate.

E. C. A.

Exchange Compensation Allowance.

Y. M. D.

Years, Months, Days.



General Provident Fund

Indian Civil Service Provident Fund deductions (if any)

(Signature) _________


Date ___________


1. Distinguish leave granted on medical certificate from leave granted without medical certificate, and if the leave, though technically of the later description, was granted in consequence of the production of a medical certificate or on medical grounds, mention the fact.

2. Except in the case of Chaplains, leave-salary should be stated in whole rupees only a month (fractions being omitted and the next higher rupee taken where the fraction exceeds half) and not in pounds a year; and in entering " the rate of leave-salary" it should be stated in the first place, without reference to the maximum or minimum applicable and then if a maximum or minimum applies or if the leave-salary is such that a future change in the current rate of exchange may render a maximum or minimum applicable the words should be added "subject to maximum (or minimum) of", etc.

3. The ordinary rate of conversion will be the rate of exchange for telegraphic transfers from Calcutta on London on the day on which each monthly payment is made subject to a minimum rate of 1s. 4d per rupee in respect of leave salary drawn on account of the first four months of leave on average pay and of 1s 6d per rupee in other cases. The maximum rates of leave-salary are those prescribed in *Fundamental Rule 89, and the minimum rates are those prescribed in Fundamental Rule 90.

4. It must be shown whether a government servant is entitled to the full amount of leave permitted by the rules.

5. In line 7 the articles of the Fundamental or other rules under which the advance is made should be mentioned.

6. The date on which any government servant will, during the currency of leave, complete the term of service, or attain the age after which by any rule he is required to retire from service, should be shown in line 10.

7. These rules apply also to leave-salary certificates granted to non-gazetted government servants when they proceed on leave out of India and draw their leave-salary out of India.

In such cases the fact that the government servant is a non-gazetted servant should be noted against entry 2.


*In the case of Government servants subject to the Uttar Pradesh Fundamental Rules, the rates as prescribed in rules 89 and 90 of those rules.

8. In preparing the leave-salary certificates of the subscribers to the Indian Military Service Family Pension regulations and to the India Military Widows and Orphans Fund, who take leave under the Fundamental Rules, the instructions given in Government of India, Finance Department letter no. 914 F.E., dated the 10th May, 1922, should also be observed, viz., the leave-salary certificate should show clearly the rate of leave-salary, the monthly maximum of average pay whether it is likely to become effective or not, and the period for which the leave-salary is not subject to the monthly maximum.

9. The following particulars should be noted in line 8;

(1) the major, minor and detailed head of account;

(2) whether debitable to central or provincial revenues; if the later, the name of the provincial government;

(3) * * *

(4) whether the expenditure is "voted or charged".

When the head of account to which the leave-salary is debitable during extensions of leave differs from the head to which it was debitable during the period of leave originally granted, this fact should be indicated.

10. In line 11, if the leave granted is less than 22 months, calculations up to 28 months, absence only may be given in the first instance, and as soon as the leave is extended so as to bring the total period of absence from duty to 22 months or more, an amendment to the original leave-salary certificate should be issued at once showing the amount of further leave due on medical certificate beyond 28 months.

11. In the case of government servants to whom the rules regarding the grant of passages to civilian personnel of British domicile engaged for service in India apply, an additional entry should be made showing whether they and their families were given the benefit of rule 7, and whether they were allowed a similar benefit under either rule 7 or rule 8 on returning to India.

12. In all English Leave-Salary certificates the particulars of all outstanding advances (including passage advances) should be noted under item 16, and in the case of motor car and similar advances the date from which the recovery of monthly instalments should be effected should be stated.

13. With the exception of privilege leave earned in a civil department which should be taken first, a military officer in civil employ may set off the leave he takes against the civil leave or military leave at his credit as he likes. A definite election in the matter should be obtained from all such officers, and his election should be noted in the Leave-Salary certificate.

14. Where subscriptions or recoveries relate to sterling branches of Provident Funds this should be indicated clearly under item 16.

                                                            back2_b.gif (10045 bytes)    home4_b.gif (7945 bytes)