Department of Labor and Employment

Regional Office V
Legazpi City
LEAVE VALIDATION FORM
From: _MARCH 16, 2020____________________ to ____APRIL 12, 2020__________________
Date Covered from the time of Flexible Work Arrangement or Temporary Closure

A B C D E F
Available Leave Credits
Number of affected days Number of days charged
Additional from the time of closure or Number of days without
No. Name of Worker/s Salary per day from closure or reduced to leave credits with pay.
allowances, if any. reduced workhours pay
workhours/ workdays (Applied leave)
(SIL/VL/SL)
Ex DELA CRUZ, Juan A. 310.00 None 10 18 5 8
1 ABELLA, JELLIAN B. 310.00 NONE
2 ASIS, DIANE E. 310.00 NONE
3 BALMEO, DIANA THERESA M. 310.00 NONE
4 BORJA, ARBEL C. 310.00 NONE
5 CAMINO, REMIE ANN A. 310..00 NONE
CORONEL,MARY JOYCE KIMBERLY NONE
6 310..00
J.
7 CALANDRIA, ROCHELLE E. 400.00 NONE
8 ELNAR, MARIA AMELYN D. 310.00 NONE
9 ESPINA, LOWELLA MAE F. 350.00 NONE
10 GONZALES, CATTLEYA E. 310.00 NONE
11 MAGANA JESSALYN C. 310.00 NONE
12 MARTINEZ, RAMILM. 310.00 NONE
13 MARTINEZ, DIANE M. 310.00 NONE NONE NONE NONE NONE
14 NAJERA, JOLINA S. 350.00 NONE
15 OBOG, ELEONOR V. 310.00 NONE NONE NONE NONE NONE
16 RACASA GEMMALYN M. 350.00 NONE NONE NONE NONE NONE
17 RAMOS ANALYN A. 310.00 NONE NONE NONE NONE NONE
18 SOLSONA LITO L. 340.00 NONE
19 SOLSONA RHEA L. 350.00 NONE
20 VILLAFRANCA, MANELYN M. 310.00 NONE
21 VILLAFLORES, DANICA L. 350.00 NONE
22 VIL;LAGARCIA LEO M. 310.00 NONE
23 VILLALUZ, JESSA MAY V. 310.00 NONE

Important Notes: Name of Establishment: Certified Correct by:

1. This form is to determine and validate whether or not the worker has used his/her leave credits. ___________________________________
This will also serve as certification of the employers on leave credits of workers. ___________________________________
2. The financial assistance to the affected worker is a lump sum worth Php 5,000.00 regardless if he or she Address:
___________________________________
___________________________________
____________________________
Name & Signature
Date: _______________________
 has used/exhausted/not used the leave credits.
3. Misrepresentation, falsification or tampering may render the CAMP Application invalid, denied or disapproved.
4. Use additional sheet if necessary.