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Leave Request from Employee - Template, Sample Form Pro · PH-law

✓ Valid in Philippines · drafted to comply with local law

Create your Leave Request from Employee - Template, Sample Form for use in Philippines. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.

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Leave Request from Employee - Template, Sample Form
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Re: Application for Sick Leave


Dear ________,


§ 1. Purpose of this Letter. I respectfully submit this letter to formally apply for sick leave from my position as ________ with ________ (the “Company”). My Employee Identification Number is ________, and I have been employed with the Company since ________.

§ 2. Period of Leave. I intend for my sick leave to commence on ________ and to conclude on ________, covering a total of ________ working day(s). I expect to resume my duties on ________, subject to the recommendation of my attending physician.

§ 3. Reason for Leave. The reason for this application is ________, which prevents me from satisfactorily discharging my functions during the above period.

§ 4. Medical Certification. In compliance with the Company’s policies and the applicable provisions of the Labor Code of the Philippines, I have attached herewith a copy of the medical certificate issued by ________ of ________, dated ________, attesting to my condition and recommending the foregoing period of rest and recovery. I undertake to follow the medical advice of my physician for the duration of my leave.

§ 6. Turnover of Duties. During my absence, I will ensure that my pending tasks and responsibilities are properly delegated or attended to, so as to minimize any disruption to the operations of the department. I am also willing to provide any necessary turnover, briefing, or instructions to my colleagues prior to the commencement of my leave.

§ 7. Contact and Availability. Should any urgent matter requiring my attention arise during my leave, I may be reached at ________ or by email at ________. In the event that I am unreachable owing to my medical condition, I shall be pleased to address any outstanding matters promptly upon my return.

§ 9. Undertaking. I undertake to ensure that this application is forwarded to the appropriate department for proper documentation, and to comply with such further requirements as the Company may reasonably impose in relation to this leave.

I thank you for your kind consideration and understanding of this request.


Respectfully yours,



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Acknowledged and received by:


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Date received: ________

Enclosure: Medical Certificate dated ________

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