HERBERT SMITH

HISWARA BUNJAMIN & TANDJUNG

LEAVE OF ABSENCE

2011Please complete the form, sign at space provided and obtained approval by Partners before submitting to the Office Manager

NAME: Rangga Dahana

POSITION: Junior Associate

DATE OF APPLICATION: 4 August 2011

Type of Leave applied for:(Annual

(please tick in appropriate box)(Sick

(Exam/Study

(Other (please specify)

NO. OF DAYS APPLYING FOR: 6 days

From (date): 8 August 2011

To (date): 15 August 2011

Resume duty on (date): 16 August 2011

SIGNATURE OF APPLICANT:

Date: 4 August 2011

APPROVED BY (Signature):

Date:

Entitlement check and fill in by:EK

No of day(s) remaining this calendar year:

No of day(s) applying for this form:

No of day(s) remaining this calendar year after this leave: