HUMAN RESOURCES DEPARTMENT

PHILSAGA MINING CORPORATION Document No. PMC-HRD-CB-FRM-003

FORM Revision No. 00
Leave of Absence Request Effective Date 01-SEPTEMBER-2018
Page 1 of 1

Employee Number Date Filed

Employee Name Department Electrical
Position Section
Job Category Shift Schedule
Division MINE Day Off
TYPE OF LEAVE
Vacation Leave Maternity Leave Leave for Victims of VAWC
Sick Leave Paternity Leave Special Leave For Women
Service Incentive Leave Solo Parent Leave Roster Break
Others, please specify
Total Number of
From To
Days Requested
Reason
Requested by: Approved by:

Engr. Felix S. Sumagang

Signature over Printed Name of the Department/Division
Signature over Printed Name of the Employee / Date
Management / Date
HR DEPARTMENT USE
Type of Leave Leave Balance Leave Availed Remaining Balance Without Pay

Recorded by: Checked by

HUMAN RESOURCES DEPARTMENT

PHILSAGA MINING CORPORATION Document No. PMC-HRD-CB-FRM-003
FORM Revision No. 00
Leave of Absence Request Effective Date 01-SEPTEMBER-2018
Page 1 of 1

Employee Number Date Filed

Employee Name Department Electrical
Position Section
Job Category Shift Schedule
Division Mine Day Off
TYPE OF LEAVE
Vacation Leave Maternity Leave Leave for Victims of VAWC
Sick Leave Paternity Leave Special Leave For Women
Service Incentive Leave Solo Parent Leave Roster Break
Others, please specify
Total Number of
From To
Days Requested
Reason
Requested by: Approved by:

Engr. Felix S. Sumagang

Signature over Printed Name of the Department/Division
Signature over Printed Name of the Employee / Date
Management / Date
HR DEPARTMENT USE
Type of Leave Leave Balance Leave Availed Remaining Balance Without Pay

Recorded by: Checked by