REPUBLIC OF THE PHILIPPINES

INTER-AGENCY COMMITTEE ON CIVIL REGISTRATION AND VITAL STATISTICS: CARAGA

REGION

ANNEX A
LIST OF UNREGISTERED LEARNERS

Name of School: _______________________

Address (Brgy., City/Municipality, Province): _____________________________
Division: _____________________________

Full Name of the Learner

Grade Level Section
(First Name, Middle Name, Last Name)

Total No. of Unregistered Learners: _____

Note: Suffix like Jr., II, III or the like shall be included after the First Name.

Prepared by: Submitted by:

_________________________ __________________________________
(Signature Over Printed Name) (Signature Over Printed Name of the School
Head)