Republic of the Philippines

CITY OF TARLAC
GRADE 4-6

Name of School: SAN SEBASTIAN ELEMENTARY SCHOOL Grade Level: FIVE Section: MARCOS

10pcs-Writing Notebook (80’s, 30x14.8x0.81cm) 1pc-Pencil, 1pc-Black Ballpen, 1pc-red Ballpen, 1pc-Rubber Eraser, 1box-Crayon
(24 pcs), 1pc-Sharpener, 1 Pad Paper- Grade Pad/80’s, 1pc-Correction Tape, 1pc-Math Notebook, 1pc-Spelling Booklet, 1pc-
Pencil Case (17mmx210mm), 1pc- Short Brown envelope, 10pcs-Short Bond Paper, 1pc-Drawing Book (20’s/A4Size) 1pack-
Colores Paper (Assorted/Short), 1pc-Scissors (minimum 4-inch size), 1pc- Glue, 1pc-Ruler, 1pc-Bag

This is to certify that we have received the following items:

LIST OF BENEFICIARIES

NAME NAME
(Male) (Female)
1. Abejo, Mhel Joshua H. 1. Cabrera, Ayesha M.
2. Alejaga, Nathaniel D. 2. Cadimas, Catherine G.
3. Billaba, Wesley T. 3. Carigma, Jessica B.
4. Bituin, Emanuel C. 4. Camadizo, Jazmin D.
5. Castro, Justine M. 5. David, Jenna Dennise H.
6. Corcuera, Redsel E. 6. Dela Cruz, Daryan L.
7. David, John Peter A 7. Fortich, Princess D.
8. Espinosa, Aiden Cal P. 8. Fruto, Jaydelyn B.
9. Gazmin, Paul Jake B. 9. Barcelona, Andro
10. Iglesias, John Dale Y. 10. Gomez, Althea Jane Q.
11. Lacerna, Alexander D. 11. Mallari, Carla D.
12. Macapagal, Gian Carl B. 12. Macalong, Lhianne
13. Manarang, BJ S. 13. Pitolan, Chloe Louise P.
14. Mendoza, Prince Ryan B. 14. Sarmiento, Cathleen S.
15. Palma, Elijah Khalil B. 15. Arce, Hygiene M.
16. Patricio, Carl Jayson L. 16.
17. Posadas, Reynald E. 17.
18. Puno, Alkean Emyrr G. 18.
19. Rigor, Jacob Daniel M. 19.
20. Sanggalang, Kadmiel Troy 20.
21. Mariano, Tyrone 21.
22. Quilbio, Ziean Zeovry 22.
23. 23.
24. 24.
25. 25.
26. 26.
27. 27.
28. 28.
29. 29.
30. TOTAL 30.
TOTAL

Total no. of Enrollees: 37 Total no. of Kits Received: __________

Certified Correct by:

_____________________________________
Printed Name and Signature

_____________________________________
Contact Number

______________________________________
Date
Grades 4-6 (2023)

10 pcs Writing Notebook, (80’s,

30x14.8x0.81cm)
1 pc Pencil
1 pc Ballpen Black
1 pc Ballpen Red
1 pc Rubber Eraser
1 box Crayon (24’s)
1 pc Sharpener
1 pad Paper (Grade pad/80’s)
1 pc Correction Tape
1 pc Math Notebook
1 pc Spelling Booklet
1 pc Pencil Case (70mmx210mm)
1 pc Short Brown Envelope
10 pcs Short Bond Paper
1 pc Drawing Book (20’s/A4 size)
1 pack Colored Paper (Assorted/Short)
1 pc Scissors (minimum 4-inch size)
1 pc Glue
1 pc Ruler
1 pc Bag