Civil Service Form No.

6
Revised 2020

Republic of the Philippines

National Bureau of Investigation
Stamp of Date of Receipt
V-Tech Tower Bldg. G. Araneta Avenue cor Maria Clara St.,
Quezon City

APPLICATION FOR LEAVE

1. OFFICE/DEPARTMENT 2. NAME (Last) (First) (Middle)
Cybercrime Division LORENZO VICTOR V.

3. DATE OF FILING March 10, 2022 4. POSITION Head Agent 5. SALARY P 0.00_____

6. DETAILS OF APPLICATION
6. A) TYPE OF LEAVE TO BE AVAILED OF 6. B) DETAILS OF LEAVE

Vacation Leave (Sec. 51, Rule XVI, Omnibus Rules Implementing E.O. No. 292) In case of Vacation/Special Privilege Leave
Mandatory/Forced Leave (Sec. 25, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Within the Philippines Residence_______________
Sick Leave (Sec. 43, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Abroad (Specify) _____________________________
Maternity Leave (R.A. No. 11210 / IRR issued by SCS, DOLE, SSS)
In case of Sick Leave
In Hospital (Specify Illness)___________________
Paternity Leave (R.A. No. 8187 / CSC MC No. 71,s. 1998, as amended)
Out Hospital (Specify Illness)_________________
Special Privelege Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
__________________________________________________
Solo Parent Leave (R.A. No. 8972 / CSC MC No. 8,s. 2004) In case of Special Leave Benefits for Women:
Study Leave (Sec. 21, Rule XVI, Omnibus Rules Implementing E.O. No. 292)
(Specify Illness) __________________________________
__________________________________________________
10-Day VAWC Leave (R.A. No. 9262 / CSC MC No. 15,s. 2005)
In case of Study Leave:
Rehabilitation Privilege (Sec. 55, Rule XVI, Omnibus Rules Implementing E.O. No. 292) Completion of Master’s Degree
Special Leave Benefits for Women (R.A. No. 9262 / CSC MC No. 15,s. 2005) BAR/BOARD Examination Review
Special Emergency (Calamity) Leave (CSC MC No. 2,s. 2012, as amended)
Other purpose:
Monertization of Leave Credits
Adoption Leave (R.A. No. 8552)
Terminal Leave
Others: Force Leave
________________________________________
6. C) NUMBER OF WORKING DAYS APPLIED FOR: 6. D) COMMUTATION
Half Day_______________________
Not Requested
INCLUSIVE DATES Requested
_ March 10, 2022__________
HA VICTOR V. LORENZO
Chief, Cybercrime Division
(Signature of Applicant)
7. DETAILS OF ACTION ON APPLICATION
7. A) CERTIFICATION OF LEAVE CREDITS 7. B) RECOMMENDATION
as of _______________________
For approval
Vacation Leave Sick Leave
For Disapproval due to ______________________
Total Earned
_____________________________________________
Less this application
_____________________________________________
Balance

__________________________________ VICENTE A. DE GUZMAN

(Authorized Officer) Assistant Director for Investigation Service
Authorized Official
7. C) APPROVED FOR: 7. D) DISAPPROVED DUE TO:
_______ days with pay __________________________________________________
_______ days without pay __________________________________________________
_______ others (specify) __________________________________________________

__________________________________
(Authorized Official)
 GUIDELINES ON FILING OF APPLICATION FOR LEAVE OF ABSENCE

INSTRUCTIONS

1. Application for vacation or sick leave for one full day or more shall be made on this Form.
2. Application for vacation leave shall be filed in advance or whenever possible five (5) days before going on such
leave.
3. Application for sick leave filed in advance, or exceeding five (5) days shall be accompanied by a medical
certificate. In case medical consultation was not availed of an affidavit should be executed by the applicant.
4. An employee who is absent without approved leave shall bit be entitled to receive salary corresponding to the
period of his unauthorized leave of absence
5. An application for leave of absence for thirty (30) calendar days or more shall be accompanied by a clearance
from money and property accountabilities.