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Pass Slip Sample

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REPUBLIC OF THE PHILIPPINES REPUBLIC OF THE PHILIPPINES

Municipality of Alfonso Municipality of Alfonso


Alfonso, Cavite Alfonso, Cavite

PASS SLIP PASS SLIP

Date:________________ Date:________________

Permission is requested to leave the Municipal Permission is requested to leave the Municipal
Hall Premises during office hours. Hall Premises during office hours.

Purpose: ( ) Official ( ) Personal Purpose: ( ) Official ( ) Personal

Reasons:_____________________________________ Reasons:_____________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________

_________________________ _________________________
Employees Signature Employees Signature
Above Printed Name Above Printed Name

No Objections: No Objections:

________________________ ________________________
Department Head Department Head
Signature Above Printed Name Signature Above Printed Name

Approved: Approved:

MYLENE V. QUILALA MYLENE V. QUILALA


OIC-Human Resource Management Office III OIC-Human Resource Management Office III
______________________________ ______________________________
(To be filled up by Security Guard on Duty) (To be filled up by Security Guard on Duty)
Time of Departure:__________ Time of Departure:__________
Time of Arrival:__________ Time of Arrival:__________

_______________________ _______________________
Officer on Duty Officer on Duty
REPUBLIC OF THE PHILIPPINES
Municipality of Alfonso
Alfonso, Cavite

PASS SLIP

Date: _______________

Permission is requested to leave the Municipal Hall during office hours.

Purpose: ( ) Official ( ) Personal

Reasons: ____________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________

______________________________
Employees Signature
Above Printed Name
No Objections:

______________________________
Department Head
Signature Above Printed Name

Approved:

MYLENE V. QUILALA
OIC-Human Resource Management Officer III
________________________________________________________________________________________________________________________________
(To be filled up by Security Guard on Duty)
Time of Departure:_______________
Time of Arrival:_______________

______________________________
Officer on Duty

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