.

'f::"5,
ls.,p Dci^.n-,r.ot o[ Daucrtlolr Xitior.t Crpitrl R?tlor
sDo - rJL"ezol crry, Ricoros itt:ton

Sepublir ot Oe ?bilirrinrg
Depurtment of Gtucstior
National Capital Region
RETEA$ED
Schools DivisioD Office of Quezon City

DIVISION MEMORIINDUM
N". ll9. , s.2O2l
3 May,2O2l

AMEIVDMENT TO OMNIBUS RI,LES ON LEAVE

(CSC MC No. 41, s. 1998, as ameadedl

TO Assistant Schools Division Superintendents

Assistant Department Head III
Chief, Education Supervisor, Curriculum Implementation Division
Chief,Education Supervisor, School Governance and Operations Division
Education Program Supervisors / Specialists
Public Schools Division Supervisors
School Heads
Section / Unit Heads
All Others Concerned

1. Pursuant to CSC MC No. 5, s. 2O21 and CSC Resolution No. 2100020

promulgated on Januar5r 7, 2021, the Commission amended items (p), 8 to lO
and 15 to 25, Rule I and Sections 11 to 20, Rule XVI of the Omnibus Rules
Implementing Book V of Executive Order (E.O.) No.292, also known as the
Omnibus Rules on kave (CSC MC No.41, s. 1998, as amended), which cover
the provisions of the civil service rules on maternity leave, paternity leave, and
adoption leave ald prescribed the use of the revised Application for kave (CS
Form No. 6, Revised 2O2Ol and, the Notice of Allocation of Matemity Leave (CS
Form No. 6a, s. 2O2Ol.

2. Enclosed are the following:

a. CSC MC No.5, s.2021

b. Revised Application for Leave (CS Form No. 6, Revised 2020)
c. Notice of Allocation of Maternity kave (CS Form No. 6a, s. 2O2Ol

3. Immediate and widest dissemination of this Memorandum is enjoined.

RPUZ, CE.SO VI
Schools Division Superintendent

@lr"r, EcUa St. Bago Bantay Quezon city

sdo.quezoncity@deped.gov.ph
o (8)3s2-680s, (8)3s2-6804

@ @ www.depedqc.ph
 Sepublir ot tle Fbilimine,
Desurtment of @lucution
National Capital Region
Schools Division Office of Quezon City

Encl.: As stated

Reference:

To be indicated in the Perpetual Index

under the following subjects:

AMENDMENT
FORMS
LAWS

EBM/ Amendment to Omnibus Rules on Ieave (CSC MC No. 41, s. 1998, as amended)
May 3,2021

Onuove rsp *. &a*o grnir,y udcl€t?

&w O (E)3q2=5805, (8)3s2-6804
$ -o.qr"ron.,rygro"peo.gor.pn 6 www.depeo'qc.ph
 crvfl.rfnucoM t,55,ot{
Republit of the Philippines

MC No.;!-, s. 2021

MEMORANDUM CIRCULAR

TO ALL HEADS OF CONSnTUTIONAL BODIES; DEPARTITIEi{TS,

BUREAUS, AND AGENCIES NATIONAL OF THE
GOVERNiIENT; LOCAL GOVERNUENT UNITS; GOVERNMENT-
OWNED OR CONTROLLED CORPORATIONS wlTH ORIGINAL
CHARTERS; ANo STATE UNIVERSITIES AND COLLEGES

SUBJECT Amendment to Omnibus Rules on Leave (CSC MC No.41, s.

1998, as amended)

Pursuant to CSC Resolution No. 210OO2O promulgated on 07 January 2021,lhe

Commission amended ltems (p), 8 to 10 and 15 to 25, Rule I and Sections 11 to 20, Rule XVI
of the Omnibus Rules lmplementing Book V of Executive Order (E.O.) No. 292, also known
as the Omnibus Rules on Leave (CSC MC No. 41, s. 1998, as amended), which cover the
provisions of the civil servicc rules on matemity leavet, patemity leave2 and adoption leave3
and prescribed the use of the revised Application for Leavea (CS Form No.6, Revised 2020)
and the Notice of Allocation of Matemity Leaves (CS Form No. 6a, s. 2020), as follows:

"RULE P
"COVERAGE AND DEFINITION OF TERMS

"(p.) The following terms used in Rule XVI shall be construed as follows:

xxx
"8. Pregnancy refers to lhe period from the conception up to the time
before actual delivery or birth of a child, miscaniage ot emergency
termination of pregnancy.

"9. Matemity leave refers to the leave of absence for pregnant female
govemment employees for one hundred tive (105) days with full
pay, to provide them with ample transition time to regain health and

1 Pu|Eiwnt to RA No. 11210 or the 10*Day Expandad Matemv Leave Law.

2 Purcuant to RA No. 81 87 or the Patemv Leave Act 0f . 19
3 Pursuant to RA No. 8552 or the Domestic Adoption Act of 1998.

'5Annex A
Annex B
6An enatum was published in the Daily Tibuno on 22 Apil 2021: "Due to enor in transcdption, the numbering on
pages 3 (items 17 to 25) and 4 (items 17 to 21), Rula I (Covenge and Dofrnition of Tetms), CSC RosoLrl,bn No.
21OOO2O dated TJanuary 2021 (Amondment to the Omnibus Rules on Leave ICSC MC No. 4r, s. ,998, es
omandedl) should have read as items 15 to 25 and items 15 to 19 resryctively."

Bawat Kawani, Lingkod Bayani

gCSC Euiuing,lEP Road. Batasan Hills, ll25QuezooCity ? lO2) 931-7935/l\21931-7939l(02) 93'l {092 O cscphil@sc.gov.ph I www.csc.gov.ph
AmendnBnt to Omnibus Rules on Leeve
(CSC MC No. 41, s. 1998, as amendod)
Page 2 of 9

overall wellness as wel/ as assume matemal roles before resuming

paid wo*.7

"10. Paternityr Leave refers to the leave of absence for manied male
govemment employees for seven (7) days with full pay, to enable
them to lend care and suppoti to their legal spouses before, duing
and afrer childbirth as the case may be and assisf in reaing of the
newborn child.

xxx
"15. Additional maternry leave benefits refers to the additional
maternity leave benefrt of 15 days with full pay on top of the 105-
day maternity leave benefit for a female employee who qualifies as
solo parent under the Solo Parents' Welfare Act of 2000.

'16. Extended maternity leave refers to the additional matemity leave

of up to thirty (30) days without pay, or with pay charged against
sick or vacation leave credits, which the female employee may avail
of in case of live childbirlh to ertend the one hundred five (105)-day
expanded matemity leave, provided that a written notice is
submitted to the agency head at least forty-five (45) days before the
end of matemity leave.

"17. Allocation of maternity leave credits refers to the option of female

employee to allocate a maximum of seven (7) days of the one
hundred five (105)-day expanded matemity leave to the child's
father or, in case of his death, absence or incapacv, to an altemate
caregiver.

"18. Pre-natal care refers to the porlion of the matemity leave of not
more than forty-five (45) calendar days priorto delivery when female
worker may be placed on full bed rest or bed rest throughout most
of their pregnancy if they have a high-risk pregnancy.s

"19. Post-natal care refers to the poftion of the matemity leave of not
/ess than sixty (60) calendar days afrer delivery to allow the female
worker to rest and recuperate from child delivery as well as to
provide her an opportunity to breastfeed and bond with her newborn
child.

"20. Permanent incapaclty refers to complete physical, mental or

psychological deficiency, disability or illness which renders a parent
incapable of complying with parental obligations, as ceftitied by a
com pete nt med i ca I practitio ne r.

1 Malemity teave of sW (6q cfays, with tutt pay, shatl be Wnted for miscariage or emergency temination of pregtancy.

3
https://americsnpreqnancy.org/pregnancy-compllcations/bed-reau
Anetinant to Onnibus Rules on Leave
(CSC MC ,vo. 11, s. 1998, as amen&d)
Paga 3 ofI

"21. Adoption leave refers to leave of absence granted to a government

employee (adoptive parent) to provide an opportunity to develop
bonding with the adoptee who is below seven (7) years of age.

"22. Adoptive parentladopt$ refers to a male or female govemment

employee who is qualified to adopt under Section 7 of the Domestic
Adoption Act of 1998, who shall undergo superuised trial custody
and/or has obtained a decree of adoption from the court.

"23. Pre-Adoptive Placement Authority (PAPA) refers to the notice of

approval from the Regional Director of the Depaftment of Social
Welfare and Development (DSWD) on the placement of the adoptee
to the prospective adoptive parents from which the supevised tial
custody shallcommence. (Sections 22 and 23, Article V, IRR of R.A.
No.8552)

"24. Government employee refers to a person in govemment sevice

who, in accordance with existing laws, rules and regulations, hold
public otrice by viftue of an appointmenf issued by the proper
appointing officer/authority or by way of election in National
Govemment Agencies (NGAs), Local Govemment Units (LGUs),
Govemment-Owned or -Controlled Corporations (GOCCs) with
oiginal charters, State Universities and Colleges (SUCs), or Local
Universities and Colleges (LUCs).

"25. Employment status refers to the status of appointment. lt may be

permanent, temporary, provisional, coterminous, fixed term,
substifute, casual or contractual.

xxx
"RULEXW
"LEAW OF ABSE'VCE

xxx
"Sec. 11. Grant of Maternity Leave. - Every female employee in
the government service, regardless of her civil status, employment status,
length of seruice and legitimacy of the child, in addition to her vacation and
sick leave credits eamed, shall be granted one hundred five (105) days
matemity leave with full pay for live childbirih regardless of the mode of
delivery, whether normal or caesaian.

"For cases of miscariage or emergency termination of pregnancy,

matemity leave of sixty (60) days with full pay shall be granted.

"The female employee shall give prior notice to the authoized officer
of her agency of her pregnancy and her availment of matemity leave at least
Amendnent to Omnibus Rules on Leave
(CSC MC No. 4r, s. 1998, as amended)
Poge 4 otI

thirty (30) days in advance, whenever possible, specifying the effectivity of

the leave. Civil Seruice (CS) Form No.6, Revised 2020, shall be used infiling
matemity leave application with medical certificate.

"ln case the female employee qualifies as a so/o parent under R.A.
No. 8972 or the "Solo Parents' Welfare Act of 2000", she shall be granted an
additional matemity leave of fifreen (15) days with full pay.

"Female teachers may also avail of the matemity leave benefits even
duing long vacations, i.e., summer and Chnstmas vacations, in which case,
both the matemity leave benefits and the proportional vacation pay (PVP)
shall be granted.

"Matemity leave shall be non-cumulative and non-commutative (non-

conveftible to cash). The enjoyment of matemity leave cannot be deferred
but paft of it may be availed of on or before the actual date of delivery in a
continuous and unintemtpted manner.

"Sec. 12. Extended Maternity Leave. - ln case of live childbirth, the

female wo*er has the option to ertend her maternity leave for an additional
thirty (30) days without pay, or use her earned sick leave credits for ertended
leave with pay. ln case the sick leave credits are exhausted, the vacation
leave credits may be used.

"Due notice must be in writing and must be submifted to the authoized

officer of her agency or the authoized official at least fotty-five (45) days
before the end of the female workels matemity leave. However, no pior
notice shall be necessary in the event of a medical emergency but
subsequent notice shall be given to the authorized official.

"The above peiod of extended matemity leave without pay shall not
be considered as gap in the seruice.

"Sec. /3. Frequency of the Grant of Maternity Leave. - Maternity

leave shall be granted to a female employee in every instance of pregnancy,
regardless of frequency.

"ln case of overlapping benetit claims, the female employee shall be

granted matemity benefits for the two contingencies in a consecutive manner.

"The female employee shall be paid only one matemity leave benetit,
regardless of the number offsping, per childbirlh/delivery.

"Sec. 11, Tenure of Female Employee Availing the Expanded

Maternity Leave. - The availment of maternity leave shall rtot be used as
basis for the diminution or reduction in rank, status or salary of the female
employee or termination of her employment.
Amednent to Omnibus Rules on Leave
(CSC MC No- 41, s. 1998, as amended)
Page 5 of 9

"Sec. 15. Metemity Leave After Terminalion of Employment -

Matemity leave with full pay shall be granted even if the childbirth, miscarriage
or emergency termination of pregnancy occurs not more than tifreen (15)
calendar days after the termination of employee's seruice as her rtght thereto
has already accrued.

"However, in case of illegal termination of employment, the

prescriptive period of fifteen
5) calendar days shall not apply and the female
(1
employee shall be paid, based on her salary, the full amount of the one
hundred five (105) days maternity leave for live childbirth or sirty $0) days
for miscarriage or emergency temination of pregnancy, as lhe case may be.

"Sec. 16. Matemity Leave of

Employee with Pending
Administntive Case. -
Matemity leave benetits shall be enjoyed by the
female employee even if she has a pending administrative case.

"Pending administrative case refers to a period while the case is

pending investigation and resolution. lt includes the peiod of preventive
suspension and pending appeal with the Civil Service Commission.

"ln case the female employee delivers a child while under preventive
suspension orseruing the penalty of suspension, she will be allowed to enjoy
the matemity leave from the date of delivery, miscaniage or emergency
termination of pregnancy until the full enjoyment of the said leave. ln such
case, she sha// be required to seve the unexpired portion of her suspension.

"However, a female employee who delivers a child after a decision in

an administrative case, finding her guiw with a penafty of dismissal from the
seruice, became final and executory shall not be entitled to matemw leave.

"Sec. 17. Allocation of Materniflr Leave Credits. - A female

employee may avail of the option to allocate up to seven (7) days of her
matemity leave to the child's father, whether or not she is manied to him. The
allocated leave is over and above the seven (7)4ay patemity leave benefrt
under R.A. No. 8187 or the "Patemity Leave Act of 1996".

"ln case of death, absence or incapacity of the child's father, the

female employee may allocate to an altemate caregiverwho may be a relative
within the fourih degree of consanguinity or cunent paftner shaing the same
household, taking into account the best interest of the child.

"The allocated leave may be enjoyed by the child's father or the

altemate caregiver either in a continuous or in an intermiftent manner not later
than the period of the matemity leave availed of.

"The allocation of matemity leave shall only be available to the child's

father or aftemate caregiver who are employed either in the public or pivate
sector.
Anondnant to Omnibus Rules on Leave
(CSC MC IVo. 41, s. 1998, as anended)
Pdgc 6 of I

"The option to allocate is not applicable to matemity leave ln cases of

miscaniage and emergency termination of pregnancy.

"Civil Service (CS) Form No. 6a, s. 2020 shall be used as notice of
allocation of matemity leave and shall be submifted to the authoized officer
of the agency with the filled out Application for Leave form (CS Form No. 6,
Revised 2020) and proof of relationship.

"ln the event the female employee dies or ispermanently

incapacitated, the balance of her matemity leave benefits, if any, shall accrue
to the child's father or the altemate caregiver, subject to the following
conditions:

"(a) That the maternity leave benefits have not yet been
commuted to cash; and

"(b) That a certified true copy of the death cettificate or medical

ceftificate or abstract are presented to the
agenciedemployers of both the female employee and child's
father or altemate caregiver.

"ln case full pay has been given to the female employee, the child's
father or altemate caregiver, as the case may be, shall only be excused from
work (leave without pay). Such leave without pay by the child's father or
afternate caregiver shall not be considered as a gap in the seruice.

"Sec, /8. Dispute Resolution. - Any dispute, controversy or claim

aising out of or relating to the payment of matemity leave with full pay shall
be filed by the concerned female employee initially to the head of agency and
may be appealed to the Civil Service Commission (CSC) Regional Office
having jurisdiction over the agency, and to the Commission Proper,
respectively. The agency shall not hold or delay the payment of full pay to
the female employee pending the resolution of the dispute, controversy or
claim.

"Sec. 19. Grant of Patemity Leave. - Every manied male employee

in the govemment seruice shall be entitled to patemry leave of seven (7)
working days with full pay for the tirst four (4) deliveies, whether childbirth or
miscaniage, of his legitimate spouse Mlh whom he is cohabiting.

"The first of the four (4) deliveies shall be reckoned from the etrectivity
of the Patemity Leave Act on July 15, 1996.

"A male employee with more than one (1) legal spouse sha// be
entitled to avail of patemity leave for an absolute maximum of four (4)
deliveies regardless of whoever among hls spouses deltver.

"Paternity leave of seven O) days shall be non-cumulative and strictly

non-convertible to cash. The same may be enioyed either in a continuous or
Amendment to Onmibus Rules on Leave
(CSC MC No. 41, s. 1998, as aoBnded)
Page 7 of 9
x----
in an intermittent manner by the employee on the days immediately before,
duing and after the delivery of his legitimate spouse, buf not later than the
period of the matemity leave availed of by the spouse.

"A manied male employee shail be entitled to paternity leave by

accomplishing and tiling the Application for Leave form (CS Form No. 6,
Revised 2020) within reasonable peiod, e.9., one (1) week, pior to the
expected delivery except r,h cases of miscaniage and abnormal deliveies.
Approval of the leave application shall be mandatory on the paft of the
approving authority unless the serwbes of the male employee are urgently
needed to preserue life and property in which case the male employee shall
be entitled to overtime pay.

"Any employee who has availed of the patemity leave may be required
to furnish his office a ceftified true copy of his maniage contract, birth
ceftificate of the newbom child, medical ceftificate with patholory report in
case of miscariage duly signed by the attending physician or midwife
showing the actual date of delivery.

'Sec. 20. Grant of Adoption Leave. A female government

-
employee, regardless of her civil status and employment status, and length
of service who qualifies as an adoptive parent under R.A. No. 8552 or the
"Domestic Adoption Act of 1998" and whose prospective adoptee is below
seven (7) years of age as of placement, shall be qualified to avail adoption
leave of sixty (60) days with full pay, which leave shall be enjoyed in a
continuous and unintemtpted manner. lf she is manied, her legitimate spouse
(govemment employee) can avail of adoption leave ot seven (7) days with fuil
pay which shall be enjoyed in a continuous or in an intermiftent manner.

"A single male govemment employee, regaridless of employment

status and length of seruice who qualifies as an adoptive parent under R.A.
No. 8552 and whose adoptee is below seven (7) years of age as of
placement, shall be entitled to adoption leave of sixty (60) days with tull pay,
which leave shall be enjoyed in a continuous and unintemtpted manner. The
same pivilege may also be enjoyed by a manied male employee with an
u ne mployed (w ffe) spou se.

"Adoption leave shall provide an opportunity for the prospective

adoptee and the adoptive parenus to develop bonding similar to that between
a child and his/her biological parents.

"Application for adoption leave shall be filed using Civrt Senace (CS)
Form No. 6, Revised 2020, and accompanied by an authenticated copy of the
Pre-Adoptive Placement AuthoriU issued by the Department of Social
Welfare and Development (DSWD), if the leave will be availed of before the
grant of petition for adoption.
(CSC MC wo. 41, s. 1998, as angn&d)
Page I ofI

"tf adoption leave is avaited after the grant of the petition for adoption'
the apptication for leave shalt be accompanied by the authenticated copies of
the Decree of Adoption issued by the proper coutt."

ln addition, the Commission adopted the following guidelines:

1. Qualified female employees who gave live childbirth or suffered miscarriage

and emergency termination of pregnancy upon the effectivity of R'A' No' 1 1210
on 11 March 2019 but were only granted less than what is stipulated under the
new law, shall be entitled to one hundred five (105) days or sixty (60) days with
full pay, as the case may be. Concomitantly, they may resume their remaining
matemity leave and receive unpaid matemity leave benefits due them, provided
that they notify their agency/office heads in writing using the Application for
Leave form (CS Form No. 6, Revised 2020). Female employees whose sick or
vacation leave credits were deducted following the application of the old
maternity leave law, rules and regulations, shall be entitled to restoration of the
same.

2. All employees shall use the prescribed revised Application for Leave Form
(Civil Service Form No. 6, Revised 2020) with the lnstructions and
Requirements found in Annex A and the Notice of Allocation of Matemity
Leave (CS Form No. 6a, s. 2020) found in Annex B as applicable.

3. The use of CS Form No. 4'l for leave application shall be discontinued.
Consequently, employees may secure a medical certificate issued by a
govemment or non{ovemment physician in whatever form in support of their
application for leave, provided that the medical certificate bears complete
details of the physician (e.9. name and PRC/license, PTR and 52 numbers),
the employee, and the employee's condition/state of health.

The following CSC issuances relative to matemity and paternity leave have been
amended accordingly:

CSC Memorandum Circular No. 14, s. 1999 (Additional Provisions and

Amendments to CSC Memorandum Circular No. 41, 1998)

CSC Memorandum Circular No. 22, s. 2OO2 (Amendment of Section 11, Rule
XVI of the Omnibus Rules lmplementing Book V of the Administrative Code of
1987)

CSC Memorandum Circular No. 13, s. 200/. (Claification on Matem@ Leave

Policies)

CSC Memorandum Circular No. 1 , s. 2O18 (Amendment to Section 20 of the

Omnibus Ru/es on Leave on the Peiod Within Which to Avail of Paternity
Leave)
Amendment to O,1.mibus Rures on Lsavs
(CSC MC ,Vo 41, s. 1998, ds at6nded)
Page I ol9

Consequently, the provisions of CSC Memorandum Circular No. 8, s. 2003

(Amendment to Section 24 of CSC MC No. 41, s. ,998 on Computation on Leave Monetization
and Reiteration of Policy on Matemity Leave) have been repealed.

CSC Resolution No. 2100020 shall take effect on 24 Apnl 2021 or after frfteen (15)
days from its publication in the Daily Tribune on 08 April 2021, provided that the amendment
to the rules on maternity leave shall apply to female employees who gave live childbirth,
suffered miscaniage or emergency termination of pregnancy from the effectivity date of
Republic Act No. 'l 1210 on 1 1 March 2019.

dela ROSA-BALA
Chairperson

28 April2021
CS Form iro, 6a ANNEX B
Series ot 2020

NOTICE OF ALLOCATION OF MATERNITY LEAVE

I. FOR FEMALE EMPLOYEE

IIAME (Las, Nan e, Firs, Name, Name Ertensk,r'l, if any, and Middle Name) POSITION

HOME ADDRESS AGENCY and ADDRESS

CONTACT DEIAILS (Phone nunbet aN e-rnail add'iess)

I am allocating _ days (7 days rnax.) ot my 1054ay matemity leave to Mr./Ms. _,

which benelit is granted under Republic Act No. 11210 or the 1oUDay Expanded Matemity Law. Attached is the proof of our
eldtionship.

SIGNATURE OVER PRINTED NAME DAIE

II. FOR CHILD'S FATHERYALTERNATE CAREGIVER

NAME (Last Name, First Name, Name Extension, if any, and Middle Name) POSITION

HOME ADDRESS AGENCY / EMPIoYER and ADDRESS

CONTACT DETAILS (Phone numbr and e-nail adress)

RELATIONSHIP TO THE FEMAI.E EMPLOYEE

(Please ma* the box with \") I accopt the all@ated _ days o{ the 1054ay matemity leave
from lhe aborenenlioned lemalo employee and tlwe submit lhe attached
trChild's father proot ot ou relationship. lt is understood that the allocated matemity leave
I
EAltemate caregiver is tot the care of ourher newbom child.
tr Relative within fourth degree of consanguinity
(Specify
ECunent partner sharing the same household
SIGNATURE OVER PRINTED NAME DATE

PROOF OF RELATIONSHIP
(Please mafu the bx with "x' and aftach a photocopy of the docunat)
D Child s Binh Certiftcate D Maniage Certificate I
Barangay Cenificate DOther bona fide documenus that can
prove filial relationship

III. FOR THE HRMO AND THE HEAD OF OFFICE/AUTHORIZED OFFICIAL

APPROVEDI
cerlity that Ms.
I has
a matemv teave balance d_ days. Fuftheinote, I have
eviewed and evaluated the attached suppoding d@umenls
and find the herein allocation of matemity leave in ordeL
SIGNATURE OVER PRINTED NAME
Head of Office/Authori zed Otficial

SIGNATURE OVER PRINTED NAME DATE

HRMO DATE
AGENCY, ADDRESS and CONTACT DETAILS

I
crttl *ttb lsm rb,6
MM ANNEX A
Republic of the Phlllpplno.
AGENCY
LOGO (Agency N.me) SErrlp ol 0.16 d Roc.hl
(Agency Ad.lr.s"e)

APPLICATION FOR LEAVE

1, OFFICE/DEPARTMENT 2, NAME (Last) (Firso (Middle)

3. DATE OF FILING 4, POSITION 5. SALARY

6, DETAILS OF APPLICATION

6.A TYPE OF LEAVE TO BE AVAILED OF 6.8 DETAILS OF LEAVE

fiVacation Leave {s*.51. Rd. xvt, omtr R'*r rrdr'urt{ E.O No. z€2) ln caso ol Vacatio,t/Special Piyilege Leaw:

ElMandatory/Forced Leave(s& 2r. Rd. xvl. Orr&,. kL.lndaprhs E.o. ilo. 2€2)
f]wffrin tle enitippines
f]S"l L"""" (s.c 13, Rd.IM, mB RuL. liddrl1t{ E.o om) l-'lmr*o tso".it"t
EMatemity Leave Fr. No. 11210 / rRR rlol.d by csc, DotE rld SSS) ,, c€se ofSick Leaye.'

f]Patemity Leave 1nA ih.8187 i csc rtc No. ?r, !. 1906,.! rnddod) Eln Hospital (Speciry lllness)

flSp€dat erivitege l-eave {s6c. 21. tur6 xar, omtrjs Rd.s r'ndemrifu E.O. No. 292)
EOut Pstient (Specify lllness)

[Sob Parent Leave (R ilo. / csc uc no. !. rtr)

os7z E,

[St ay Leare {S* ea Rl. }M, Om.t . hJ.! rnuiisrh0 E.o. No. 2o2) ln c,s€ d S,€dd Leave a€lnefts lot WooDn:

E1o-Day VAWC Leav6 G t|o.52O / cs,,c tirc ito. i5.1arF) (Specrfy llness) _
f]R"n"Uitit tion erivilege (s-. s5. Rd. xvr, otrrl' to/d hdcrsxi[ E.o. rb. a2)

flSpociat teave aenefits for Women 6A No. e7i0 / csc Lc iro 25, !. m10) ln case of Study Leave:

[SprOd er"rg"n"y (Calamity) Lsave (csc llc ih.2, a 2012,6 Elldlded]

Ecompl€tion ot Maste/s Degree
flAdopdon Leaveln,t no. urozy flBARrBoard Examination Review
Other put"0'se:
Othors:
fiMonetization of Leave credits
ITerminal Leave

6,C NUMBER OF WORKING DAYS APPLIED FOR 6,D COMMUTATION

INot ReQuested
INCLUSIVE DATES
f]ReQuesteo

(Signature of Applic€nt)

7. DETALS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.8 RECOMMENDATION
As of
lFor aoomvat

E fotal Eamed
Vacation Leave Sick Leave ElFor disapproval due to

Less this application

Balance

(Authorizod Oflicer) (Authoriz8d Offcer)

-
7.C APPROVED FOR: -- 7,D DISAPPROVED DUE TO:
_ dqls ith -
pay r

_ dals withoot pay

_ oth€G (Specify)

(Authorized Offcial)
 INSTRUCTIONS AND REQUIREMENTS

Application for any rype of leave shall be made on this Form and lqbg TPo or PPO has been filed $/ith the said offce shall be suffcient
accomDlished at least n duDlicate wib documentary requirements, as to supporl the application for the ten{ay leave; or
follows: d. ln he absence of fle BP0fiPO/PPO or the certification, a police
report specirying the details of ttle occunence of violence on the
l. Vacatlon leave' viclim and a medical certificate may be considered, at the
It shall be filed five (5) days in advance, whenever possible, of the discretion of the immediate supeMsor of the woman employee
efieclive date of sudr leave. Vacation leave wihin in he Philippines or concemed.
abroad shall be indicated in t|e ffin fo{ purposes of seardng bavel
auhority and completing dearance fto money and wort '10. Rehabilitalion leave* - up to 6 monthg
accountabilities. o Application shall be made within one ('l) week from the time oflhe
accident except when a longer period is wananted.
2. l$andatoryiForcod loave . Letter request supported by relevant repoG sudt as tfle police
Annual fiveday vacation leave shall be forfeited if not taken during he report, if any,
year. ln case the scheduled leave has been cancelled in the exigency o Medical certifcate on he nature of the injuries, the cours€ of
of he service by the head o, agency, it shall no longer be deducled from treatment involved, and he need to underyo rest, recuperation, and
he acormulated vacation leave. Availment of one (1) day or more rehabilitation, as he case may be.
Vacaton Leaye (VL) shall be considered for complyng the . Wrilten concunence of a govemrnent physician should b€ obtained
mandatory/forced leave subjed to the mndfions under Seclion 25, Rule relawe to [|e re@mmendation for rehabilitation if he attending
XVI of the Omnibus Rules lmplementjng E.0. No. 292. physician is a private practitioner, particularly on the duration of the
period of rehabilitation.
3. Sic* leave"
. tt shall be filed immediately upon emdoyee's retum from sudt leave. II . Special leava benefits tor womea' - up to 2 months
. lf filed in advan@ or exceeding five (5) days, applicalion shall be . The application may be liled in advance, thal is, at least fve (5) days
acmmpanied by a EedigalglIlgeE. ln case medical mnsultation prior to the sdeduled date of he gynecological surgery that will be
was not availed of, an affdavit should be exeofied by an apdicant. urdergone by the emdoyee. ln case of emergenry, the application
for special leave shall be filed immediately upon employee's retum
4. atamlty leaYe'- 105 days but during confnement the agency shall be notified of said suryery.
o Pmof of pregnancy e.g. ulfasound, docto/s certificate on the . The application shall be accompanied by a medical certificate filled
expected date of delivery out by the proper medical au$oities, e.g. $e attending suEeon
r Acmmplished Notice of Allocaton ol Matemity Leave Credits (CS accompanied by a clinical summary rsflecting he gynecdogical
Form No. fu), if needed disorder which shall be addressed o( was addressed by he said
. Seconded female employees shall enjoy matem$ leave witt full pay surgery; the histopathological repo( the operative tednique us€d
intle recipient agency. for the surgery; the duration ol the surgery including fre peri-
operative period (period of mnfinement around surgery); as well as
5. Patemity leaYe-7 days the emdoyees estimated period ol rediperation for fte same.
Proof of drild's delivery e.g. birfi cerfficate, medical certifcate and
maniage contract ,2. Special EmBrgency (Galamlty) leave - up to 5 days
. The special emergency leave can be applied for a maximum ol five
6. Special Privilsgo loave - 3 days (5) straight working days or staggered basis wihin hirty (30) days
It shall be filed/approved for at least one (1) week prior to availment, from he acfual occufience of he nalural calamity/disaster. Said
except on emergsncy cases. Sp€cial privilege leave within the privilege shall b€ enjoyed once a year, not in every instance of
Philippines or abroad shall be indicated in the form for purposes of calamity or disaster.
searring bavel au$ority and completing dearance from money and wo* . The head of offce shall take full responsibility for the grant of special
accountabilities. emeqeflcl leave and verification ol he employee's eligibilrty to be
granted thereol Said veffication shall indude: validation of place of
7. Solo Parenl leaYe - 7 days residence based on latost available records of the affeded
It shall be filed in advance or whenevel possible five (5) days before emdoyee; verification that the place of Issidence is covered in $e
going on sudr leave with updated Solo Parent ldentiication Card. dedaralion of calamity area by he proper govemment agencyi and
sudr o$er prooft as may b€ necessary.
8. S-tudy lsave'- up to 6 months
. Shall meet lhe agencys intemal requkements, if any; 13. onetization of leave credits
. Contrad beween the agency head or aufiodzed Iepresentative and &plication for monetization ol fifry percent (50%) or more of the
he employee concemed. acomulated leave credits shall be accompanied by letter request to
the head ofthe agency stating tle valid and juslifiable reasons.
9. VAWC leave - '10 days
. lt shall be filed in advance or immediately upon ltre woman 14. Teminal loavo'
employee's retum from sudl leave. Prool of emdoyee's resignalion or retirement or separation lrom he
r lt strall be accompanied by any of he fdlowing supMng documents: seNice.
a. Barangay Proteclion fter
(BPo) obtained fIDm the barangay;
b. Temporary/Permanent Proteclion Order rPo/PPO) obtained from 15. Adodion Loavc
the court; o wih an aufienticated
Applicalion for adoption leave shall be liled
c. I he protedion order is not yet issued by the barangay or the court, copy of lhe Pre-Adoptive Placement Aulfruity issued by fie
a certificatjon issued by the Punong Balangay/Kagawad or Department of Social Wellare and Development (DSWD).
Pmseortor or he Clert of Court that he application for the BPo,
CS ForD lvo. 6a ANNEX B
Sorles ol 2020

NOTTCE OF ALLOCATION OF MATERNITY LEAVE

I. FOR FEMALE EMPLOYEE

NAME (Last Narro, First Name, Na,P,o Ertohsion, it shv, ahd Middb Name) POSITION

HOME AODRESS AGENCY and ADDRESS

CONTACT DETAILS (Phone numbet and e-mail address)

I am allocating _ deys (7 days max.l of my 1 054ay matomv loava to Mt./Ms

which t,€nefit is gtanted undet Rapublic Acl No. 11210orthe 105aay Expdnded Matemv Law. Attached'ts the proof ot our
rclationship.

SIGNATURE OVER PRINTED NAMF DATE

II. FOR CHILD'S FATHER/ALTERNATE CAREGIVER

NAME (Last Name, First Name, Name Extonsion, ifany, and Middl€ Name) POSITION

HOME ADDRESS AGENCY / EMPLOYER and ADDRESS

CONTACT DETAILS (Phono nunbor and e-mail address)

RELATIONSHIP TO THE FEMALE EMPLOYEE

(Please md* the tu)x with ,1 I aciapt the dll@dted _ ddys of the 1054ay matemity leave
from the aboveflpntioned female employee and L/we submit the attehed
trChild's tathsr prool of our Blationship. lt is unds6td that the allocated matemity leave
EAn6mal6 ca,ggiver is tot the ca@ ot our/l6t newboh child.
tr R6laiiv6 within fourth degIg€ of consanguinity
(Specily
ECunent partner shadng the sam6 housohold
SIGNATURE OVER PRINTED NAME DATE

PROOF OF RELATIONSHIP
(Please ma* the bx with T and aftach a phd@y ol tfi€ docwiE,nt)
tr Child's Birth Certificate E Maniage Certificate E Earangay Certifrcate tr Oth€r bona fide documenus that can
pmve 6lial relationship

III. FOR THE HRMO AND THE HEAD OF OFFICE/AUTHORIZED OFFICIAL

APPROVED:
cenily that Ms.
I has
a matemity leave balaDce ol _days. Fudhemorc, lhave
Dviewed and evaluated the attehed supre,ding d@urpnvs
and frnd the herein a @ation of matemv leave in order
SIGNATURE OVER PRINTED NAME
Head of Offce/Authorized Official

SIGNATURE OVER PRINTED NAME DATE

HRMO DATE
AGENCY, ADDRESS and CONTACT OETAILS
 lnstructions

1 The form shall be used as written notice of the female employee to her agency
regarding her allocation of a maximum of seven (7) days from the 105-day
expanded maternig leave.

2. The form shall be accomplished in three (3) copies: copy for the female employee;
copy for the agency; and copy for the agency/employer of the child's
father/alternate caregiver.

3. The form with proof of relationship shall be attached to the Application for Leave
(CS Form No. 6) of the female employee.

4. The authorized official shall forward the copy for the agency/employer of the child's
father/alternate caregiver.

5. ltem lof theform shall be accomplished bythefemale employee. Sheshall provide

the required personal and agency information, the number of maternity leave days
sought to be allocated and the name of the recipient of the allocated leave. She
shall affix her signature over printed name with date of signing.

6. ltem ll of the form shall be accomplished by the child's father/alternate caregiver.

He/she shall provide the required personal and agency/employer information and
he/she shall affix his/her signature over printed name with date of signing.

7. ltemlll of theform shall reflect the name of the female employee and her maternity
leave balance. This part shall be accomplished and signed by the Human
Resource Management Officer (HRMO) in the agency. lt is a ministerial duty of
the head of office or his/her authorized official to approve said allocation and
indicate the date of signing. The agency, thru the HRMO, is responsible to forward
a copy of the accomplished form to the agency/employer of the child's
father/alternate careg iver.