For a start, consider the wording of the statement. The fact that the concept of "time off" just isn't in TK of the Russian Federation. It would be correct to call it - an extra day off with the obligatory indication of the time when I was processing. That is, if you had the fact of working overtime, you may be given a day off on your application and with the consent of the management. In this case, you will be paid a full day as a waste.
In addition, the wording "off for your account" legally incorrect. If you want to get an unpaid day off, you can take it off. In this case, you will need to write in the statement the request for leave without pay.
Proceed to the registration statement. This document always be the name of the first head in writing. So take a standard sheet of office paper and write in the upper right corner details of the addressee and of the sender in the format "to" and "from whom". Here specify the position of the head, the name of the company, and the name and initials of the head. Next, their own position, name of structural division in which you work, own name, name and patronymic. In the Central part of the sheet write the name of the document: "the Statement".
An appeal to the head taken issue with the request "I Beg You to grant me." Next, use your chosen option for the provision of the day. For usage write off "an additional day off for worked overtime" and be sure to specify the date of processing. To receive unpaid leave "holiday at own expense" and explain what holiday it may be available to you. For example, annual paid leave. In any case, specify the exact date of the day you want to release for ourselves.
Sign the application, put the date of its publication. Take the document for signature to the head. Don't forget to register it at the Secretary as an incoming document.
Before proceeding to the registration statement, don't forget to agree on the possibility of using off with your immediate supervisor.