Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

Region IV-A (CALABARZON)
Andenson Building 1, National Highway, Brgy. Parian
City of Calamba, Laguna
Tel: (049)8274755/(049)8274587/(049)8274560 • Fax: (049) 8274745
Email: dilgcalabarzon@yahoo.com • Website: www.calabarzon.dilg.gov.ph

PERMIT TO LEAVE THE OFFICE

No :__________________
Date : __________________
Permission is requested by Mr./Ms. ______________________________________________ to leave
the office for the following purpose (s).
_________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________________________________________.
Place to be visited: ____________________________________ Time of Departure: ______
____________________________________ Time of Return : ______
Date: __________________________

Signature of Requesting Employee (s)

___________________________________
Employee(s) to perform official function and claim for
travelling expenses is hereby authorized.
Yes No
Approved:

__________________________________________
(Name and Signature of Authorized Official )

Copy for Personnel Section, FAD

Republic of the Philippines

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT
Region IV-A (CALABARZON)
Andenson Building 1, National Highway, Brgy. Parian
City of Calamba, Laguna
Tel: (049)8274755/(049)8274587/(049)8274560 • Fax: (049) 8274745
Email: dilgcalabarzon@yahoo.com • Website: www.calabarzon.dilg.gov.ph
PERMIT TO LEAVE THE OFFICE
No: ____________________________
Date: __________________________
Permission is requested by Mr./Ms. ______________________________________________ to leave
the office for the following purpose (s).
_________________________________________________________________________________
__________________________________________________________________________________________
_____________________________________________________________________________.

Place to be visited: _____________________________________ Time of Departure: ______

____________________________________ Time of Return : ______
Date: __________________________

Signature of Requesting Employee (s)

____________________________________
Employee(s) to perform official function and claim for
travelling expenses is hereby authorized.
Yes No
Approved:

_______________________________
(Name and Signature of Authorized Official )
Employee’s Copy