Republic of the Philippines

DEPARTMENT OF EDUCATION
Region III
Division of City of San Fernando
City of San Fernando (P)

Tel. No. (045) 636-4209, (045) 636-4233, (045) 455-1952

Fax No. (045) 636-4233, (045) 455-1952

The City Schools Division Superintendent

DepEd, Division of City Schools
City of San Fernando

Madam:

I have honor to inform your good office that I will be ready to return to duty as Permanent
Employee, effective on ______________________, I was granted leave of absence on account of
________________________ from ___________________ to ___________________ inclusive on
Civil Form 6 dated _____________________.

The Medical Certificate (General Form 86) signed by the school physician and the Birth
Certificate of my child (if maternity) are hereby attached.

Very truly yours

_______________________
Signature

Employee No: ________________________

Noted by:

__________________________
School Head