APPLICATION FOR LEAVE

CC Form No. 6
Revised 1994
Date Entered Service:
9

1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle) (QLFR) ( Badge Nr)

3. DATE OF FILLING 4.RANK/ POSITION & STATUS OF APPMT 5. SALARY

6a. TYPE OF LEAVE 6b. WHERE WILL BE SPEND

( ) VACATION
( ) To seek employment
( ) Others (specify)
______________________________
______________________________
______________________________
( ) SICK
( ) MATERNITY
( ) Others (Specify)
_ ________ _____________
IN CASE OF VACATION LEAVE:
( ) Within the Philippines
( ) Abroad (Specify)
IN CASE OF SICK LEAVE:
( ) In Hospital (Specify)___________________
( ) Out Patient (Specify) __________________
8 7748909 8

7c. NO OF WORKING DAYS APPLIED FOR: d. COMMUTATION

( ) Requested
( ) Not Requested
INCLUSIVE DATES:

_______________________
(Signature of Applicant)

ADDRESS:

DETAILS OF ACTION OF APPLICATION

8a. CERTIFICATION OF LEAVE CREDITS b. RECOMMENDATION

As of _______________________ ( ) Approval
( ) Disapproved due to:
Vacation Sick Total
____________________________________

Admin PNCO (Authorized Official)

9a. APPROVED FOR: b. DISAPPROVED DUE TO:

_____________ Days with pay _____________________

_____________ Days without pay _____________________
_____________ Others (Specify) _____________________

________________________________
FERDINAND ORCALES DIVINA
Police Senior Superintendent
Acting Provincial Director, Bulacan PPO

Date:___________________