Australia Indonesia PartnershipKemitraan Australia Indonesia

LOCAL GOVERNANCE INNOVATIONS FOR COMMUNITIES IN ACEH (LOGICA 2)

LOGICA 2 is an initiative under the Australia Indonesia Partnership, and is delivered by

Coffey International

Development in Association with Forum Bangun Aceh (FBA)

LEAVE

APPLICATION

FORM

Date: 12 Juli 2011

Applicant Name:

Baihaqi Location: Aceh Tamiang

I hereby apply for 2 days working days leave. The dates of such leave are

From 18 July 2011

To 19 July 2011

Including

0 Public Holidays

My last days at work will be: 15 July 2011

My first day back at work will be: 20 July 2011

TYPE OF LEAVE (please tick)

Annual Leave V Sick Leave Unpaid Leave

Other Leave (Specify)

Remaining Leave per Annum (days)

JOB HANDOVER ARRANGEMENT

Job No. / Description

Person Taking

Over Notes / Special Instructions

Signature of Employee:

Baihaqi

Acknowledged by DM:

M. Yusran

Leave approved by (Supervisor):

Fauzi Aksana

Reviewed by Personnel Manager : Leave approved by COO: