Republic of the Philippines

DEPARTMENT OF EDUCATION
Region V
DIVISION OF CAMARINES SUR
BAGACAY HIGH SCHOOL
Bagacay, Tinambac, Camarines Sur

TEACHER’S CLEARANCE
_____________________
( Date )
_______________________
_______________________
_______________________

SIR / MADAM

I have the honor to inform you that I have satisfactorily completed / accounted all money / forms and
school property for which I am responsible in this institution and all that required of me have been submitted on
the dates shown below:

1. SF 1 _______________________________
2. SF2 _______________________________
3. SF 3 _______________________________
4. SF 4 _______________________________
5. SF 5 _______________________________
6. FORM 48 _______________________________
7. FORM 137 A _______________________________
8. PTA FUND _______________________________
9. Accomplishment Report _______________________________
10. Final Report _______________________________

PURPOSE OF THIS CLEARANCE

_____________ Registration _______________ End-Year Report
_____________ Transfer _______________ First Day of Service
_____________ Leave _______________ Absences during the school year

REMARKS: _________________________________________________________________________

_________________________
Name and Signature of Teacher
Clearance Recommended:

AIDELIZA BUENAFLOR BABY LUDY D. ABLAZA RUBELINE P. BELCHES EVA T. HIMANTOG

PTA Treasurer Property Custodian Faculty Treasurer Disbursing Officer

LILIA R. NACARIO
School Head

FIRST ENDORSEMENT

BAGACAY NATIONAL HIGH SCHOOL

Bagacay, Tinambac, Camarines Sur, Philippines

Respectfully forwarded to the Schools Division Superintendent, Freedom Sports Complex, San Jose, Pili,
Camarines Sur, the last day of service of this teacher in this school was ________________.

The above statements are true and correct, complete and additional clearance hereby granted.

LILIA R. NACARIO
School Head