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Republic of the Philippines Republic of the Philippines

Department of Education
Region IV-A
Department of Education
Region IV-A

SCHOOLS DIVISION OF QUEZON PROVINCE SCHOOLS DIVISION OF QUEZON PROVINCE

MATERNITY LEAVE (submit within two (2) weeks MATERNITY LEAVE (submit within two (2) weeks
after the date of leave ) after the date of leave )
Name: ______________________________ Name: ______________________________
District/School_________________________ District/School_________________________

(2 Copies Each) (2 Copies Each)


Civil Service Form 6 Revised 2020 (original) Civil Service Form 6 Revised 2020 (original)
District/School Clearance District/School Clearance
Medical Certificate with Documentary Stamp (1 Medical Certificate with Documentary Stamp (1
original, 1 photocopy) original, 1 photocopy)

For Live Birth - 105 days For Live Birth - 105 days
For miscarriage and emergency termination of pregnancy - For miscarriage and emergency termination of pregnancy -
60 days 60 days
For solo parent - 120 days (attach photocopy of solo parent For solo parent - 120 days (attach photocopy of solo parent
ID ID

Note: For those who wished to allocate 7 days of their leave Note: For those who wished to allocate 7 days of their leave
please refer to IRR RA No. 11210, Rule VIII Section 1 and please refer to IRR RA No. 11210, Rule VIII Section 1 and
accomplished Civil Service Form 6a, s. 2020 accomplished Civil Service Form 6a, s. 2020

DEPEDQUEZON-SDO-PER-04-027-005 DEPEDQUEZON-SDO-PER-04-027-005

Republic of the Philippines Republic of the Philippines


Department of Education
Region IV-A
Department of Education
Region IV-A

SCHOOLS DIVISION OF QUEZON PROVINCE SCHOOLS DIVISION OF QUEZON PROVINCE

MATERNITY LEAVE (submit within two (2) weeks MATERNITY LEAVE (submit within two (2) weeks
after the date of leave ) after the date of leave )
Name: ______________________________ Name: ______________________________
District/School_________________________ District/School_________________________

(2 Copies Each) (2 Copies Each)

Civil Service Form 6 Revised 2020 (original) Civil Service Form 6 Revised 2020 (original)
District/School Clearance District/School Clearance
Medical Certificate with Documentary Stamp (1 Medical Certificate with Documentary Stamp (1
original, 1 photocopy) original, 1 photocopy)

For Live Birth - 105 days For Live Birth - 105 days
For miscarriage and emergency termination of pregnancy - For miscarriage and emergency termination of pregnancy -
60 days 60 days
For solo parent - 120 days (attach photocopy of solo parent For solo parent - 120 days (attach photocopy of solo parent
ID ID

Note: For those who wished to allocate 7 days of their leave Note: For those who wished to allocate 7 days of their leave
please refer to IRR RA No. 11210, Rule VIII Section 1 and please refer to IRR RA No. 11210, Rule VIII Section 1 and
accomplished Civil Service Form 6a, s. 2020 accomplished Civil Service Form 6a, s. 2020

DEPEDQUEZON-SDO-PER-04-027-005 DEPEDQUEZON-SDO-PER-04-027-005

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