C E R T I F I C A T I O N

To Whom It May Concern:

This is to certify that PLEASE STATE YOUR NAME, a teacher of

Manuel L. Quezon Elementary School, Sta. Ana District has rendered
services during the LIS UPDATING OF LEARNERS PROFILE FOR SY 2016
– 2017 on (INDICATE DATES HERE).

Issued on (date submitted) upon the request of the above

mentioned in his desire to avail service credits from the
Department of Education based on Deped Order No. 14, s. 2016 with
references from DO 26, s. 2015; DO 19, s. 2015; DO 13, s. 2014;
and DO 53, s. 2003.

Noted by:

WEDZMER B. MUNJILUL
School LIS Coordinator

Certified by:

Approved by:

BERNARDO L. PAÑARES
Principal I EVANGELINE A. VICENCIO
PSDS – Sta. Ana District

INTEGRATED SCHOOL FORMS https://ischoolforms.tech