Leave Request Form Fields marked with * are required. Depot/Region * Employee Name * Type of Leave * ---Annual LeaveBereavement LeaveCarers Leave** Sick LeaveTime off in LieuOther ** Medical Certificate attached? ---NoYes Upload Medical Certificate if applicable Leave Requested * ---PaidUnpaid Payment Method * ---In AdvancePay week by week Leave Period First day of Leave * Last day of Leave (inclusive) * Total number of Days * Total number of Hours * By checking this box, I hereby declare and warrant that I have read and completed the leave request form and that the answers above are in every respect true and correct and that I have not with-held any material information. I also understand that this form is a leave request only and that any leave is not approved or rejected until Management review and process and leave request form officially and provide a written response to you. Please leave this field empty.