Certificate for release of salary

I have performed my duties for the month of ________,20___and taken following leave(s) during the month & enjoyed _____ Sunday(s) and _____other holiday(s) as under:-

S. No. Kind of leave Date(s) Reasons Sanctioned
Without pay ()
1 Short Leave
2 Half day Leave
3 Full day Leave
4 Sick Leave
5 Privilege Leave
6 Compensatory Leave
7 Extra-Ordinary Leave

Salary payable days (……………….)
I hereby confirmed:-
  1. That I have submitted my report on daily basis in time.
  2. That I did not repeat mistakes pointed by my seniors.
  3. That there is no pending work with me either assigned or extra.
    (if pending give reasons)

  4. Output of the month

Sign here
(Name & Designation of the employee)

Reporting Officer
Business Controller

Remarks of Reporting Officer

(I agree or disagree, in case of disagree give comments)

Sign here
(Name & Designation of the Reporting officer)

Business Controller

Remarks of Business Controller

(Ok or mention comments in case of disagree & forward to Accountant for release of salary)

Sign here
(Name & Designation of the Business Controller)