Civil Service Form No.

6 ANNEX A
Revised 2020

Republic of the Philippines

Supreme Court of the Philippines
Taft Ave. Cor. Padre Faura St.,
Ermita, Manila

APPLICATION FOR LEAVE

1. OFFICE/DEPARTMENT 2. NAME (Last) (First) (Middle)

3. DATE OF FILING _____________ 4. POSITION ___________________ 5. SALARY__________

6. DETAILS OF APPLICATION
6.A TYPE OF LEAVE TO BE AVAILED OF 6.B DETAILS OF LEAVE
Vacation Leave (Sec. 51. Rule XVI In case of Vacation/Special Privilege Leave
Mandatory/Forced Leave Within the Philippines ____________________
Sick Leave Abroad (Specify) ____________________
Maternity Leave In case of Sick Leave
Paternity Leave In Hospital (Specify) ____________________
Special Privilege Leave Out Patient (Specify Illness) ____________________
Solo Parent Leave In case of Special Leave Benefits for Women
Study Leave (Specify Illness) ____________________
10-Day VAWC Leave In case of Study Leave
Rehabilitation Privilege Competition of Master’s Degree
Special Leave Benefits for Women BAR/Board Examination Review
Special Emergency (Calamity) Leave Other purpose
Adoption Leave __________________
Others _________________ Monetization of Leave Credits
Terminal Leave
6.D COMMUTATION
6.C NUMBER OF WORKING DAYS APPLIED FOR
Not Requested
__________________________________________
Requested
INCLUSIVE DATES

__________________________________________ ________________________________________________
(Signature of Applicant)

7. DETAILS OF ACTION ON APPLICATION

7.A CERTIFICATION OF LEAVE CREDITS 7.B RECOMMENDATION
As of ________________________________
For Approval
Vacation Leave Sick Leave
For disapproval due to __________________________
Total Earned
____________________________________________
Less this Application
____________________________________________
Balance

____________________________________________
Authorized Officer
_____________________________________________
Authorized Officer

7.C APPROVED FOR 7.B DISAPPROVED DUE TO ____________________

_____ Days with pay __________________________________________
_____ Days without pay __________________________________________
_____ Others (Specify) __________________________________________
Civil Service Form No. 6 ANNEX A
Revised 2020

Republic of the Philippines

Supreme Court of the Philippines
Taft Ave. Cor. Padre Faura St.,
Ermita, Manila

________________________________________
Authorized Officer