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Leave application format — for leave or sick leave
We found no government form: a leave application is a letter to your manager or HR. Check your company’s leave rules first. Keep the reason short. If you are an ESI member, this letter alone does not get you the sickness benefit.
Updated: · Next check 2027-02-02
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Enter a date — we’ll count the deadlines
- ESI certificate to the branch bytype the date
Layers never asks for a code or payment in a message.
Check your own case.
For ESI members. Ask your branch how the days are counted.
Meera, Layers template assistant
Keep the reason short. Your manager needs dates, not details.
Send it before the leave starts if you can, and keep the date.
Deadlines
The rules, with the source
| What | Deadline | Source |
|---|---|---|
| Form | We found no government form. It is a letter to your manager or HR. Check your company’s leave rules first | OSH Code 2020; company rules |
| Earned leave | One day for every 20 days worked, once you have worked 180 days in the year | OSH Code 2020, s.32 |
| Carry forward | Up to 30 days. Days you asked for and were refused carry forward without a limit | OSH Code 2020, s.32 |
| State laws | State laws differ and have not been repealed: Maharashtra counts 240 days, Delhi gives 15 days of privileged leave and 12 of casual leave | State acts of Maharashtra and Delhi |
| ESI certificate | Take the certificate from the ESI insurance medical officer to your ESIC branch within 3 days, or you can lose days of pay | ESI (General) Regulations 1950, unofficial copy |
| ESI sickness benefit | About 70% of wages, up to 91 days in two benefit periods. The first 2 days are usually not paid | Code on Social Security 2020; ESI (Central) Rules, r.22 |
There is no single leave number for all of India. esic.gov.in did not open, so ESI pages were read from the archive. The ESI rules are being replaced in 2026, so form numbers are left out.
What does not exist
Be careful with these.
- “One leave number for all of India”: The OSH Code and state laws differ. Check your company rules and your state.
- “A letter to HR gets you ESI pay”: ESI members need the certificate at the ESIC branch.
Step by step
What to do, in order
1
Read your company rules
Check them first, and note how many days you have.
2
Fill in the letter
Dates, type of leave and a short reason. No need for more about your illness.
3
Name who covers
Say who takes your pending work and how to reach you.
4
Send it to your manager and HR
From the document, or by your company’s system. Keep the date.
5
ESI member?
Take the certificate to your ESIC branch within 3 days.
6
Keep a copy
The letter, the reply and every certificate.
Questions
Is there a government leave application form?
We found no government form. It is a letter to your manager or HR.
How much earned leave do I get?
Under the OSH Code, one day for every 20 days worked, once you have worked 180 days in the year. State laws differ.
Do I have to give my diagnosis?
Do not write more about your illness than you need to. A short reason is enough.
What if my leave is refused?
The refused days carry forward without a limit (OSH Code, s.32).
Does this letter get me ESI sickness benefit?
No. Take the certificate from the ESI insurance medical officer to your ESIC branch within 3 days.
Official sources
Other documents
Keep the papers in one place
Letters, receipts and notices in one folder you can share with family or a lawyer. The templates and the editor are free; Layers is free for up to 20 people.
This page helps you prepare. Company rules and state law may differ. Not legal advice.