Psu Form 113 Maternity Benefits

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PSU FORM 113 Revised 2002

DATE: October 03, 2023

PAYMENT REQUEST FOR MATERNITY LEAVE BENEFITS

DIVISION NAME/CODE: 088 - COTABATO DIVISION

STATION NAME: SALUNAYAN HIGH SCHOOL


(School for Secondary/District for Elementary)
STATION CODE: (3 digits) 560
EMPLOYEE NUMBER: 4783856
EMPLOYEE NAME: HONEYBELLE J. TAPEL
SINATURE:

PLEASE ATTACH HEREWITH THE FOLLOWING SUPPORTING DOCUMENTS:


(Each Requirements must be submitted in 2 copies only)
1. Accomplished PSU Form No. 113
2. Approved Special Order - Return to Duty
3. Approved Special Order - Maternity Leave
4. Approved Form 6 - Application for Leave
5. Form 41 - Philippine Civil Service Medical Certificate
6. Child - Certificate of Live Birth

Position: Teacher -III Salary Grade: 13

Step Increment: 1 Basic Salary: P 31, 320

Inclusive Period of Leave: May 8, 2023- August 20, 2023

Specify : M/L with full pay M/L with full pay


M/L with half pay

Please check appropriate box

ML with full pay


ML with half pay
ML incurred during Christmas Vacation
ML incurred during Summer Vacation

LITO B. GARINO, P-1


School Head

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