Unpaid Leave Request Form

Unpaid Leave Request Form

Please complete this form if you would like to request unpaid leave. Please note unpaid leave is for exceptional circumstances only.
Requester Name*

First NameLast Name
Requester Email*
example@example.com
Head of Department Name*

First NameLast Name
Head of Department Email*
example@example.com
Details of the Unpaid Leave Request

I wish to take Unpaid Leave on the following dates
Date From*

DayMonthYear
Date
Date To*

DayMonthYear
Date
Number of Days*
Reason for request*
Please verify that you are human*
Should be Empty:

Details of the Unpaid Leave Request