REQUEST FORM FOR LEAVE & UNDERTIME

To: Administrative Department

From: MARITES V. PARAGUA
Date: 1-Dec-15

This is to request that I be excused from work on :

Date Time Charge to

for the following reason/s :

ENTITLEMENT AVAILMENTS BALANCE THIS AVAILMENT BALANCE

VL 0 0 0 0 -
SL 0 0 0 -
ML
PL

rqst'd by: aprv'd by: noted by:

Employee's Signature Department Head Administrative Dept.
cc: 201;admin;payroll