Republic of the Philippines Republic of the Philippines

Department of Education Department of Education

CARAGA Administrative Region CARAGA Administrative Region
Division of SurigaodelNorte Division of SurigaodelNorte
CLAVER NATIONAL HIGH SCHOOL CLAVER NATIONAL HIGH SCHOOL
Senior High School Senior High School
Claver, SurigaodelNorte Claver, SurigaodelNorte

Receipt Form Receipt Form

Leader:_______________________ Check-out Date:_________________ Leader:_______________________ Check-out Date:_________________
Members:_____________________ Return Date :_________________ Members:_____________________ Return Date :_________________
Address:______________________ Address:______________________

Stock/ Stock/
Unit Item Description Remarks Unit Item Description Remarks
Property No. Property No.
Checked By: Checked By:
Charls John G. Ercillo Signature of borrower Charls John G. Ercillo Signature of borrower
In-charge In-charge