Employee Number ____________ 01 __________

CS FORM NO. 6
REVISED 1999

APPLICATION FOR LEAVE

1. OFFICE/AGENCY

2. NAME:(LAST)

Provincial Legal Office

3. DATE OF FILING
June 21, 2016

UY
EDGAR BANKIM
SYGACO
4. POSITION
5. SALARY(Monthly)
Administrative Officer V
PHP33,831.00

(FIRST)

(M N.)

DETAILS OF APPLICATION :
6. (a) TYPE OF LEAVE :

6. (b) WHERE LEAVE WILL BE SPENT :

Vacation
To seek employment

(1) IN CASE OF VACATION LEAVE :

Within the Philippines

Sick
Maternity
Special Privilege
Others (specify) __________________

(2) IN CASE OF SICK LEAVE :

In Hospital (specify)

Abroad (specify) ____________________

_______________________________
_______________________________

6. (d) COMMUTATION :

6.(c) NUMBER OF WORKING DAYS APPLIED FOR :

One (1) day

INCLUSIVE DATES :

Out - Patient (specify)

20-Jun-16

Requested

Not Requested

Edgar Bankim S. Uy
Signature of Applicant
DETAILS OF ACTION ON APPLICATION:
7.(a) CERTIFICATION OF LEAVE CREDITS :
7. (b) RECOMMENDATION :
As of: 31-May-15
Vacation
6.243
6.243

Sick
15.400
1.000
14.400

Total
21.650
1.000
20.650

Approved: __________________________

Edgar Bankim S. Uy
Administrative Officer V

7. ( c ) APPROVED FOR :
one (1) day with pay
day/s without pay

7. (d) DISAPPROVED DUE TO :

others (specify)

ATTY. RAFAEL R. OSABEL, JR.

Asst. Provincial Legal Officer