404722:SHS-105772

Senior High School Voucher Program (SHS-VP)

Billing Statement
School Year 2017 - 2018
First Semester

This Billing Statement also serves as the contract between DepED and the Non-DepEd School with regard to the latter's participation in the
SHS program of DepED in accordance with the program guidelines issued for the school year stated above.

All supporting information regarding this billing statement may be viewed at www.fape.org.ph.

Instructions: Please submit 4 copies.

Billed to: Date:

Department of Education November 10, 2017, 4:02 am

School ID: 404722 Billing Statement No.: 404722:SHS-105772 Full Payment

School Name: St. James College of Padre Burgos Southern Leyte, Inc.

Region: Eastern Visayas Province: SOUTHERN LEYTE Municipality: PADRE BURGOS

Total Voucher Program Beneficiaries (VPBs) and Amount Due

Grade Level No. of VPBs Total Amount Due by Grade Level

Grade 11 2 28,000.00

Grade 12 26 395,500.00

Total 28 423,500.00

I certify as correct and accurate under the penalty of perjury, all information we have provided in our school database at the FAPE website
www.fape.org.ph that are automatically translated into this Billing Statement.

Mr. Ricardo Esclamado Borces

School Administrator

Note: Signature over printed name.

Kindly deposit payment to the school's account with Land Bank of the Philippines (LBP), the details of which are as follows:

School Account Name: St. James College of Padre Burgos Southern Leyte, Inc. Senior High School Voucher Program
Account number: 0941-1088-90
Branch: Maasin City
Amount Due: 423,500.00

Requirement: Please attach an IMI1 or STI1 printout signed by the bank's branch manager.

Certified all documents complete: Endorsed for processing: Endorsed for payment:

Ms. Sarah C. Co Ramir B. Uytico,Ed.D, CESO IV Rhodora Angela F. Ferrer

FAPE Regional Program Coordinator DepED Regional Director/Representative FAPE Executive Director/Representative

Note: Signature over printed name.