APPLICATION FOR LEAVE

(PNCO & NUP)

CSC Form No. 6

(Revised No. 1984)
1. OFFICE/AGENCY 2. NAME (Last) (First) (Middle)

3. DATE OF FILING 4. RANK/POSITION 5. SALARY (Monthly)

6. a) TYPE OF LEAVE c) WHERE LEAVE WILL BE SPENT

1. IN CASE OF VACATION LEAVE
( ) Vacation ( ) Within the Philippines
( ) to seek employment ( ) Abroad (Specify)
( ) Others (Specify)

2. IN CASE OF SICK LEAVE

( ) Sick ( ) In Hospital (Specify)
( ) Maternity
( ) Others (Specify) ( ) Out Patient (Specify)
_________________________________________

b) NUMBER OF WORKING DAYS APPLIED FOR: d) COMMUTATION

( ) Requested ( ) Not Requested

Signature
INCLUSIVE DATES:

_________________________________________
Address while on Leave

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7. a) CERTIFICATION OF LEAVE CREDITS 7. b) RECOMMENDATION
As of __________________________
Approved
Vacation Sick Total
Disapproved due to

__________________ ___________________
Chief, Admin PCP Commander
NUP Nova D Villostas
OIC, PTS/DPHRDD _____________________________________
(Authorized Officer) (Station Commander/Chief of Office)

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APPROVED FOR: DISAPPROVED DUE TO:
_________________________Days with Pay _______________________________________
_________________________Days without pay _______________________________________
_________________________Others (Specify) _______________________________________

_______________________________________
(signature)
CHRISTOPHER ESCAO TAMBUNGAN
Police Senior Superintendent
DDDA
(Authorized Officer)