School Form 1 School Register for Junior High School (SF1-JHS)

School Name Samar National School School ID 303620 School District Catbalogan 1 Division Schools Division of Catbalogan City Region Region 8
Semester 0 School Year: 2017-2018 Grade Level: 10 Trackk: Academic
Section: Agoncillo Courses (only for TVL: K-12 Strand:
Age as
of 1st Guardian (if not Parent) Contact
Friday of IP Address Parent or Guardian Remarks
LRN NAME Sex Birthdate June Birth Place Mother (Specific Religion: Number
(mm/dd/yy) (Parent/Guardi
(Last Name, First Name, Middle (M/F) (nos. of (Province) Tongue: Ethnic House #/ Father (1st name Mother (Maiden: 1st an)
years as
Name) per last
Group) Street/Sitio/ Barangay Municpality / City Province only if family name Name, Middle Last Name Relationship (Please refer to the
birthday)
Purok identical to learner) Name) legend on last page)

1 123397070029 ARAZA JR, RENATO ACHEOCHE M 9/13/2002 14 Western Samar CATBALOGAN Western Samar RENATO CAJURAO ESTELITA CAPON / -
ARAZA SR. ACHEOCHE
2 406462150585 BAGASON, JHANMILL ANJOH M 1/1/1900 11 Waray Waray Catholic ANNALYN ROMA / -
DARRAS DARRAS
3 123593070010 BANTIGUE, IAN TAN M 5/26/2002 15 Western Samar 0 Waray Catholic BRGY.Karunungan, Karunungan JIABONG Western Samar RICHARD BANTIGUE FE TAN / -
Jiabong Samar
4 303620110226 BERINO, JEROME ORLAZA M 11/10/1998 18 Western Samar Guindapunan,Catbal SOCCORRO CATBALOGAN Western Samar FLORENCIO HAILEEN TULIN ORLAZA / -
ogan City BERINO,JR.
5 123409070033 CALDO, VINCENT PACAMPARA M 3/22/2002 15 Western Samar 0 Waray Catholic GUINDAPUNAN CATBALOGAN Western Samar VICTORIO CALDO MARYJAANE ISANAN Victorio Caldo Father / -
PACAMPARA
6 123423120085 CAMPOSUELO, ADRIAN N M 12/20/2001 15 Western Samar P-7 CATBALOGAN Western Samar ALLAN WILMA V.NAZARENO ROSELYN / -
BRGY.CANLAPWAS, L.CAMPOSUELO DACALLOS
7 123428070009 CURIOSO, ROGELIO CABRIGAS M 8/10/2200 -1 Western Samar Waray Catholic SOCCORRO CATBALOGAN Western Samar ROGELIO CURIOSO MINDA CABRIGAS MINDACABRIGAS MOTHER /09301178128 -

8 123419070032 DACUTANAN, JOLIUS GABANE M 5/30/2000 17 Western Samar 0 Brgy 8 Canlapwas CATBALOGAN Western Samar Jonathan L. Manzueta D. Gabane Jonathan L. father / -
Dacutanan Dacutanan
9 123397060119 Delos Reyes, Jan Jemil Labangco M 9/27/2000 16 Western Samar GUINDAPUNAN CATBALOGAN Western Samar Labogando G. Delos MINDA NAVALES / -
Reyes LABANGCO
10 123397070153 DOCABO, MACKY DASMARIÑAS M 7/5/2000 16 Western Samar 0 Catholic San Pablo CATBALOGAN Western Samar ESTRELLA DOCABO ELPEDIO P. / -
DOCABO
11 123409070062 DOMINGO, MARK PAUL MENGORIA M 2/16/2001 16 Western Samar 0 BRGY. 13 PUROK 6 CATBALOGAN Western Samar MARIANO P. FELICITAS A. / -
DOMINGO MENGORIA
12 123397070161 EBRON, JERIC LIM M 12/24/2001 15 Western Samar 0 Waray Catholic Brgy. 11, PATAG PATAG CATBALOGAN Western Samar Ronald Jamin Ebron Lida Mabulay Lim / -

13 123423070135 LIM, MARTIN BENEDICT M 7/8/2000 16 EUFENIA SABLAYON / -

14 123438070022 MONTANO, CESAR CABERTE M 9/2/2001 15 Northern Samar San Brgy. San Vicente CATBALOGAN Western Samar DANILO MONTANO MARIETA CABERTE / -
Vicente,Catbalogan
15 123419060075 Mustacisa Jr., Virgillo Navelon M 12/2/2000 16 Western Samar Waray SITIO STO. CATBALOGAN Western Samar VIRGILIO G. EMELITA D. NAVELON / -
NIÑO, BRGY. MUSTACISA SR.
16 303623120113 RODRIGUEZ, CARL LEONARD M 5/28/1998 19 Brgy Munoz CATBALOGAN Western Samar Leo Rodriguez ANTONETTE D. / -
QUIJANO QUIJANO
17 12358070009 SIAGO, JOHN LESTER DACUMA M 12/24/2001 15 Western Samar 0 Cantongtong JIABONG Western Samar ANDRONICO E. NILDA D. DACUMA / -
SIAGO JR.
18 123423060220 TABLATIN, RONEL ALEGRO M 12/5/1999 17 Western Samar MUNOZ CATBALOGAN Western Samar ROMEO TABLATIN VILMA ALEGRO / -

19 123425070024 TAMBAL, DEXTER PORTADO M 11/17/2001 15 HERMENIA MAYONGUE / -

PORTADO
20 313706130015 TIZON, WILBERT ACABAN M 9/2/1999 17 WENIFREDA SABUCO / -
ACABAN
21 131709120079 VILLALINO, ALFEMIJO N M 3/5/2002 15 CATBALOGAN CITY CATBALOGAN Western Samar ALFREDO VILLALINO / -

1 123423070027 BALASA, ERMELY NABABLIT F 7/15/2002 14 Zamboanga Del 0 Waray Catholic 10 CATBALOGAN Western Samar Erlington Balasa IMELDA NABABLIT / -
Sur
2 123479070004 BALLERES, BHENG CYRIL A. F 3/6/2002 15 Western Samar CASAB-AHAN ALLAN P .BALLERES ELLEN A. BALLERES / -
DARAM SAMAR
3 12339770074 BOHOL, MARY GRACE CINCO F 9/13/2002 14 Western Samar 0 CATBALOGAN Western Samar PABLITO Z. BOHOL LISBETH T. CINCO / -

4 123963070007 CABIGAYAN, SALLY JANE GARCIA F 3/28/2002 15 Western Samar Waray Waray Christian Zumarraga, samar Alegria ROMEO OCASLA FE PADILLA GARCIA / -
CABIGAYAN
5 123410070011 CABUENOS, CRISELDA BESTODIO F 4/4/2002 15 CAL-APOG, CESAR CABUENOS LUZVIMINDA BESTUDIO / -
CATBALOGAN

School Form 1 (SF 1) Page 1 of 2

 Age as
of 1st Guardian (if not Parent) Contact
Friday of IP Address Parent or Guardian Remarks
LRN NAME Sex Birthdate June Birth Place Mother (Specific Religion: Number
(mm/dd/yy) (Parent/Guardi
(Last Name, First Name, Middle (M/F) (nos. of (Province) Tongue: Ethnic House #/ Father (1st name Mother (Maiden: 1st an)
years as
Name) per last
Group) Street/Sitio/ Barangay Municpality / City Province only if family name Name, Middle Last Name Relationship (Please refer to the
birthday)
Purok identical to learner) Name) legend on last page)

6 123397070116 CHICO, LIRIE MAE GUTIERREZ F 3/29/2002 15 Western Samar 0 Waray Catholic Km.2 CATBALOGAN Western Samar RICHARD CHICO Ma.LYNNIE GUTIERREZ /09202655788 -

7 136647050281 DE GUIA, SHIELA MAY HIMZON F 9/1/1999 17 Western Samar 0 Catholic TUBIGAN ZUMARRAGA Western Samar RICARDO DAGAMI EMELINDA HIMZON / -
DE GUIA
8 123423070199 DIOCTON, MARY ROSE F 11/10/1999 17 IMELDA DIOCTON / -

9 123485070008 DOMINGO, MA.SHEDENE CARIG F 3/24/2001 16 DARAM,SAMAR LOSA EDWIN DOMINGO / -

10 123593050043 GABIANA, ANGELICA PACLITA F 2/5/1999 18 Western Samar Waray Catholic CALAPI MOTIONG MOTIONG Western Samar ADILINO GABIANA / -

11 123419060046 JABONERO, JENNY ROSE OCENAR F 11/1/2000 16 Western Samar 0 CANLAPAWAS CATBALOGAN Western Samar FLORO L. JABONERO MEDERITA C. OCENAR / -

12 123408060058 JOHNSON, LORNA DE LUNA F 8/28/2000 16 Zambales 0 BRGY. BUNU- CATBALOGAN Western Samar LAURESS JOHNSON LOURDES JOHNSON / -
ANAN,
13 123397120429 LABRAGUE, MAE LOURDES F 7/28/2002 14 Western Samar 0 Waray Catholic CANLAPWAS CATBALOGAN Western Samar HECTOR LABRAGUE MA. AGNES GALLARDE / -
GALLARDE
14 123932070053 MANZANO, MA. ARONA MAE SANO F 9/3/2001 15 Western Samar 0 BRGY 04 BRGY 04 CATBALOGAN Western Samar MARLON V. SANO ALICIA VASQUEN SANO PARENT / -
CATBALOGAN
15 124397070290 NIEDO, JESSA MAE SABONG F 12/25/2001 15 Western Samar 0 BRGY. 11, CATBALOGAN Western Samar IMELDA S. NIEDO / -
CATBALOGAN
16 105139070044 PAGLIAWAN, LANIE SALCEDO F 12/22/2001 15 / -

17 123844070014 PENSABER, CHABELITA A F 10/27/2001 15 Western Samar BRGY.DAPDAP TARANGNAN Western Samar JOVITO D. MA.SALLY N.ALCAZAR / -
TARANGNAN SAMAR PENSABER
18 123405070057 PONAY, JEAN FRANCIS GENATA F 12/30/2000 16 Western Samar SITIO STO. NINO CATBALOGAN Western Samar ANABELLE PONAY / -
SAN ANDRES
19 123440070010 REPUYA, JESALYN M F 4/1/2001 16 TOYTOY,GARCHITO CAMALIGAN Camarines Sur EDGAR C.REPUYA MARY ANN REPUYA / -
RENA,CAMARINES
20 123397070374 TOSTON, ALYSSA JEAN PENSABER F 8/28/2001 15 Western Samar 0 OLD MAHAYAG OLD MAHAYAG CATBALOGAN Western Samar SONNY TOSTON ANGELES D. PENSABER PARENT / -
CATBALOGAN CITY

BoSY EoSY Prepared By: Certified Correct:

List and code of indicators under REMARK column

MALE #Error #Error SANCHEZ, FERNANDO . RUTH D. CABANGANAN
Indicator Code Required Information Indicator Code Required Information
Transferred Out T/O Name of Public (P) Private (PR) School and Effectivity CCT Recepient CCT CCT Control/ref nbr and Effectivity date (Signature of Adviser over Printed Name) (Signature of School Head over Printed Name)
Transferred In T/I Name of Public (P) Private (PR) School and Effectivity Balik-Aral B/A Name of School last attended and Year FEMALE #Error #Error
Dropped DRP Reason and Effectivity Date Learner With Dissability LWD Specify SY Start Date: 6/5/2017 SY End Date: 4/6/2018
Late Enrollment LE Reason (Enrollment beyond 1st Firday of June) Accelerated ACL Specify Level and Effectivity Date
Sem Start Date: Sem End Date:

School Form 1 (SF 1) Page 2 of 2