Republic of the Philippines

DEPARTMENT OF EDUCATION
Region IX, Zamboanga Peninsula
Division of Zamboangadel Norte
District of Sergio Osmena I
NEW TAGUB ELEMENTARY SCHOOL

NATIVIDAD P. BAYUBAY
OIC Schools Division Superintendent
Division of Zamboangadel Norte
Dipolog City

Madam;

I have the honor to apply for maternity leave of absence effective _____________________to
_______________________.

Here to attached are the following to with;

1. Medical Certificate
2. Birth Certificate
3. Marriage Certificate

Hoping for your approval.

Respectfully yours,

SHEENA C. DIZON