Employee details

Dates and Days Taken

From Date:
To Date:
Total Days Taken:

Type of Leave Taken

If no medical certificate, state reason:

Signature and Online Authorisation

Signature of employee: __________________________________________

Date Signed:


1. Paternity Leave - Granted to an employee, who is a parent of a child. The employee entitled to 10 consecutive days of parental leave.
2. Study Leave - Granted day before and day of exam – Proof to be submitted.
3. Rest & Recuperation Leave - Duvet Days – not to be processed: for information purposes only.
4. Family Responsibility Leave - Granted when your child is born OR sick; OR when your spouse OR life partner OR parent OR adoptive parent OR grandparent OR child OR adopted child OR grandchild OR sibling dies.

For Office Use Only:

Days available on VIP Payroll:_____________________

If No, state reason:________________________________________________________________________

Date of Application Approved / Declined:____________/____________________/________________

Signature of Manager/Director:____________________________________________________________