Leave Form

Email*
example@example.com
Name*

First NameLast Name
Department*
Designation*
Designation*
Designation*
Designation*
Designation*
Leave Type*

Vacation LeaveSick LeaveHalf Day-VLUndertimeHalf Day-SLMaternity LeavePaternity LeaveParental Leave for Solo ParentsLeave for Victims of Violence Against Women and Their ChildrenSpecial Leave for Women (RA 9710 - Magna Carta of Women)
Number of Childbirth*
Doctor's / Medical Certificate upload*

Cancelof
Civil Status*
(Required for benefit eligibility)
Wife's Name*
Medical Certificate / Proof of pregnancy or childbirth*

Cancelof
Marriage Certificate upload*

Cancelof
Proof of Solo Parent status*

(Solo Parent ID or Certification from DSWD)
Cancelof
Purpose of leave*
(e.g., child's school activity, medical needs, etc.)
Brief description of circumstances *
(non-detailed to protect privacy)
Supporting document*

(e.g., Barangay Protection Order, Protection Order, police/medical report - upload field)
Cancelof
Medical Certificate / Clinical Abstract*

Cancelof
Hospital / Doctor's name*
Details*
Date of Surgery

MonthDayYear
(if applicable)
With PayWithout Pay
Remaining Leave Credits :*
Number of Day(s) Leave:*
Leave Start*

MonthDayYear
Leave End*

MonthDayYear
Reason/s*
Should be Empty: