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Republic of the Philippines

Department of Education
REGION IV-A
Division of Quezon
Atimonan I District
SAN RAFAEL NATIONAL HIGH SCHOOL

AGREEMENT FORM

This is to inform the following teachers who will take over in my subjects during my leave of absence
due to ________________________________________________________on
___________________________________.

Name of Teachers Subject/ Grade/Section Time Signature


1.
2.
3.
4.
5.
6.
7.

Prepared by:
______________________________
Subject Teacher
Noted by:
PRISIA IMELDA P. MIRA
Principal

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