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[Ad. G. Form F. R. 9]

FORM NO. 5

Information required by the Accountant General before the leave-salary certificate can be drawn up.

(This form should be returned duly filled up to the Accountant General, one clear week before the date of making over charge).

1. On what date do you intend to make over charge of your office?	1
2. Before or afternoon?	2
3. At what port do you intend to embark?	3
4. By what ship will you sail and on what date?	4
5. In what country do you wish to draw your leave-salary during leave on average pay for a period not exceeding four months if any at the commencement of your leave? If in India at what treasury?	5
5-A. In what country do you intend to spend vacation or/and holidays?	5-A
If out of India in what country do you intend to draw your pay (and allowances) during vacation or/and holidays?
(N.B.—The words within brackets above should be scored out by the Audit Officer in all cases in which allowances are not payable, out of India).
6. What is your address in England or in India or elsewhere to which your leave-salary certificate to enable you to draw your leave-salary may be sent in case it is not handed over to you before you go on leave?	6
7. What advances if any do you require now?	7
8. Do you intend to pay your... Civil Fund subscriptions in England or in India?	8
9. Do you wish to subscribe to the General Provident Fund? If so, for what period of your leave and at what rate?

Numbers 3 and 4 are for government servants to whom the leave rules in sections I to V of Chapter X of the Fundamental Rules are not applicable.

Number 5—Leave-salary due for the first four months of the period of leave on average pay, if any, at the commencement of any period of leave out of India can be drawn in or out of India at the government servant’s option. In India it can be drawn only on the 1st of each month in arrears by an authorized agent under a guarantee bond or on production of a life certificate. The allowances for a broken period of a month may be drawn at any time after the expiration of the leave.

Number 7 is for military officers subject to the Military Leave Rules and for Chaplains only.

Number 8 is for members of the Indian Civil Service only.

NOTE—(1) In the case of non-gazetted government servants to whom note 11 to Form no. 2 or note 4 to Form no. 3 or no. 3-A applies, an additional question should be inserted to obtain the information required under that note.

NOTE 2—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. When Form 5 is sent to such an officer question 10 should be added in manuscript. Is the leave to be set off against the military leave or against civil leave at your credit? The answer should be noted on his leave-salary certificates.

NOTE 3—Where subscriptions or recoveries relate to Sterling Branches this should be indicated clearly against question 9.

Signature-----

(Designation)-----

Dated at-----

The-----of-----19.

To the Accountant General—