Labour law the unpaid leave the employee may take only on their own (forcing it to write the application at own expense head may not). The leave without pay (this is officially called a vacation at his own expense) and regardless of seniority or vacation schedule and does not affect the duration of regular paid and the timing of its provision.
In a statement on his account, as in any other statement needs to be "cap", which indicates who the statement (name and position) who it's from (name and position) and the name of the document ("statement").
The statement should contain a request for leave without pay, and beginning and ending dates of the leave. The reason why you need a vacation, not required. At the end of the statement put the date of his writing and signature of the applicant.
Keep in mind that the employer has the right in its sole discretion to deny you vacation at his own expense. However, there are a number of cases where the law "do not let go from work you are not eligible. In particular, the birth of a child, registration of marriage or death of close relatives. Indeed in such special cases you can claim up to 5 days of unpaid leave. Also required to provide leave at the time of examinations to employees who combine work with study in high schools or students; pensioners, war veterans and some other categories of workers.