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MINISTRY OF ECONOMY

Human Resources Department


Form: ME-VIAFI-RRHH-SLP-01

Permit Authorization Form


(This form is not valid for vacation requests)

Authorized
to:____________________________________________________________________

Dependence:______________________________________________________________

1. Leaving the building: ________________Hour __________ minutes _________


2. Check-in after normal hours: _____Hour __________ minutes _________
3. Permit Date: ___________________________________________________

Official Commission: Personal matter:

IGSS (submit proof): Judicial Summons:

Others:_______________________________________________________________
(If due to urgency you attended a consultation with a Private Doctor, present invoice and prescription)

Observations:______________________________________________________

___________________________________________________________________

Entry Time: ________


Signature of the worker: _______________________

Exit Time: _________ Vo. Bo. Immediate boss: ________________________

Date of submission of the permit form:____________________________

Original: HR
Copy: applicant

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