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STUDENT’S CLEARANCE FORM

Sir/Madam:
I have the honor to inform you that I have satisfactorily accounted for all the obligations for which I am responsible in this
school for SY 2018-2019, 2nd Semester and that I have accomplished and submitted all reports required of me.
Very truly yours,
Printed Name: ___________________________________ Signature: _______________________
Grade and Section: _____________________________

SUBJECT/ANCILLARY OFFICE
Subject Signature Ancillary Office Signature
Guidance Unit:
Mr. Czerr Odranoel O. Felaire
Library:
Mrs. Mirany P. Echon
Computer Laboratory:
Mr. Paul Ameer B. Jayme
Custodian:
Mrs. Christine C. Damaso
Adviser:
ROMNICK O. SEGUIBAN
Grade Level Coordinator:
ROMNICK O. SEGUIBAN

Approved:

MERCEDITA S. FERNANDEZ
Principal II

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