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CSC Form No.

Provincial Government of Benguet
1. Office / Agency 2. Name ( Last Name ) ( First Name ) ( Middle Name )

3. Date of Filing 4. Position 5. Salary ( Monthly )

6a. Type of Leave 6b. Number of Working Days
Vacation Leave ( state reason ) Applied For:
Inclusive Dates:
/ Mandatory Leave

Sick Leave ( state reason ) Day-Off Schedule ( if applicable ):

Special Leave Privileges ( MC 6, s. 1999 )

Funeral / Mourning Leave 6c. Where Leave will be spent:
Graduation Leave 6c1. In Case of VACATION Leave
Enrollment Leave Within the Philippines
Wedding / Anniversary Leave Abroad ( Specify )
Birthday Leave
Hospitalization Leave 6c2. In Case of SICK Leave
Accident Leave In the Hospital ( Specify )
Relocation Leave
Government Transaction Leave Out Patient ( Specify )
Calamity Leave
Parental Obligation Leave 6e. Commutation
Filial Obligation Leave Requested
Others ( Specify ) Not Requested

Monetization of Leave Credits

Maternity Leave Number of Days:
Paternity Leave
Study Leave
Rehabilitation Leave
Terminal Leave Signature of Applicant
7a. 7b. Recommendations
Disapproved due to:

7d. Disapproved due to:

1. Application for vacation or sick leave for one (1) full day or more shall be made on this form to be accomplished at
least in triplicate.

2. Application for vacation leave/special leave shall be filed in advance or whenever possible five (5) days before going
on such leave.

3. Application for sick leave in advance or exceeding five (5) days shall be accompanied be a medical certificate, in case
medical consultation was not availed of, an affidavit should be executed by the applicant.

4. An employee who is absent without leave shall not be entitled to receive his/her salary corresponding to the period
of his/her unauthorized leave of absence.

5. An application for leave without pay for thirty (30) calendar days or more shall be accompanied by a clearance from
money and property accountabilities..


6a. SLP should be filed five(5) days in advance.

6b. An employee can still avail of his birthday or wedding anniversary leave if such occasion falls on either a
Saturday, Sunday or Holiday, either before or after the occasion.
6c. Employees applying for special leave privileges shall no longer be required to present proof that they are
entitled to avail of such leave.
6d. Three (3) day limit for a given year shall be strictly observed: an employee can avail of one (1) special leave
privelege for three (3) days or a combination of any of the leaves for a maximum of three (3) days in a given
year. Special leave privileges are non-commulative and stricly non-convertible to cash.
6e. Immediate family in Rule I (Definition of Terms) refers to spouse, children, parents, unmarried brothers and
sister or any relative living under the same roof or a dependent upon the employee for support.


Monetization of fifty percent (50%) or more of the accumulated leave credits may be allowed for valid and
justifiable reasons such as:
7a. Health, medical and hospitable needs of the employee and the immediate members of his family.
7b. Financial aid and assistance brought about by force majeure events such as calamities, typhoons, fire,
earthquake and accidents that affect the life, limb and property of the employee and his/her immediate family.
7c. Educational needs of the employee and the immediate members of his/her family.
7d. Payment of mortgages and loans which were entered into for the benefit or which inured to the benefit of
the employee and his/her immediate family.
7e. In cases of extreme financial needs of the employee of his/her immidiate family where the present sources of
income are not enough to fulfill basic needs such as food, shelter and clothings.
7f. Other analogous cases as may be determined by the Commission.

The monetization of 50% or more of the accumulated leave credits shall be upon the favorable recommendation
of the department head/office head and approval of the agency head and subject to availability of funds.

1. Maternity Leave
1a. Medical Certificate

2. Paternity Leave
2a. Medical Certificate of legal wife; or
2b. Birth Certificate of child

3. Rehabilitation Leave (Job related injuries/illness)

3a. Medical Certificate
3b. Report of supervisor(s) and/or Police report.

4. Study Leave
3a. Generel Clearance from money and property accountabilities.
3b. Study leave contract.

5. Terminal Leave
3a. Certification of accumulated leave creadits; and
3b. Leave ledger card(s).