Republic of the Philippines

Department of Education
Region VIII (Eastern Visayas)
Division of Leyte
Government Center, Candahug Palo, Leyte

SPECIAL ORDER
No.__________s._______

Mr./Mrs./Miss_______________________________ a _______________
of ____________________________________ iss hereby granted ________________
days of S/L,P/L,M/L of absence effective _________________________________,
computed as follows:

______days ______________________, of absence with pay from

__________ to ___________________.

______days ______________________, of absence without pay from

__________ to ___________________.

APPROVED BY AUTHORITY OF THE REGIONAL DIRECTOR:

____________________________________
(Head of Agency)