Republic of the Philippines

Department of the Interior and Local Government

BUREAU OF FIRE PROTECTION
NATIONAL HEADQUARTERS
Agham Road, Brgy.Bagong Pag-asa, Quezon City

STUDY LEAVE PROGRAM

ATTACH
Study Leave (__Board/Bar Exam; __MA Completion/Thesis Writing; 2X2
__Compre) PICTURE

APPLICATION FOR STUDY LEAVE NO.

REQUIREMENTS/SUPPORTING DOCUMENTS IN ONE (1) SET OF FOLDER WITH TABBINGS:

1. Fully accomplished application form
2. One (1) latest 2x2 picture
3. Endorsement from Immediate Superior or Head of Office/Unit Concerned thru channel
4. Service Record
5. Transcript of Records/Diploma
6. Certificate of Actual Duties and Responsibilities
7. Certificate of Completion of Academic Requirements (for Thesis Writing & Comprehensive Examination)
8. Certificate of No Pending Service Obligation and No Pending Application for Foreign/Local Scholarship
Grant (to be issued by the Chairman, PDC, N.O.
9. Certificate of No Pending Administrative or Criminal Case
10. Medical Certificate from the Chief, MDS of the BFP
11. Performance rating for the last two (2) consecutive rating periods
12. Photocopy of Residential Certificate
13. Photocopy of Receipt of enrollment from Review Center
14. Fully accomplished Leave Form
15. Itemized Leave Record

APPLICANT’S DATA
RANK: LASTNAME: FIRSTNAME:
MIDDLENAME:

DATE OF BIRTH: PLACE OF BIRTH: AGE: EDUCATIONAL ATTAINMENT/COURSE:

SEX: CIVIL STATUS: T.I.G. ELIGIBILITY:

ADDRESS: CONTACT NUMBER/S:

UNIT ASSIGNMENT/REGION: DATE ENTERED BFP DATE OF LAST PROMOTION:

SERVICE:
STATUS OF APPT. POSITION/DESIGNATION: TYPE OF SCHOLARSHIP/STUDY LEAVE
APPLIED:

TYPE OF GRANT: FINANCIAL ASSISTANCE (for ESP only):

NO. OF MOS. APPLIED: PERIOD COVERED: SERVICE OBLIGATION (inclusive dates):

_________________________
Signature of Applicant

DATE RECEIVED: RECEIVED BY:

BFP-QSF-PRMD-022 Rev. ØØ (04.26.19)