Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OFFICE OF PAMPANGA
___________________________________________________________________________________________________________

Year-End Teachers’ Clearance

School Year 2019-2020
The Principal
Sir/Madam:
This is to inform you that I have satisfactorily settled all the property and financial obligations in the school and
that I have submitted all the required reports as listed below. May I then be granted the Year-End Clearance for School
Year 2019-2020

1. School Form 1: School Register _____________ a. room keys __________________

2. School Form 2: Daily Attendance b. books –SF3 __________________
of Learners __________________ c. equipment ___________________
d. furniture ___________________
3. Grading Sheets ____________________
4. School Form 5: (Report on
Promotion & Level of Proficiency ______________ 18. Financial Obligation
Teachers Club Dues ____________________
5. DepEd Form 137 ____________________
Canteen Funds ____________________
6. DepEd Form 138 ____________________
7. Return of Unissued Cards ____________________ 19. IPCRF ____________________
8. CS Form 48 ____________________
9. Return to Duty ____________________ 20. SALN as of December 2019
10. Maternity Leave ____________________ _______________________
11. Updated Form 212 (PDS) ____________________
21. Latest Instructional Materials Prepared
12. Lesson Plans/DLL ____________________ ___________________
13. Nutritional Status
(Feeding teacher) ____________________ 22. Accomplishment Reports (if applicable)
14. Money Accountabilities ____________________ _______________
15. Property Accountabilities ____________________
16. List of Retained/
Drop-Out/ Transferred In and Out/
Failures ______________
17. Classroom inventory and room safety

In the exigency of service, I am willing to report to work and attend Summer INSET for Teachers.

Present Home Address: ____________________________________________

Telephone/Cell phone Numbers: _______________________________

_______________________________
Printed Name and Signature of Teacher
Recommending Approval:
BAC Chairman _________________________________ Date: __________________
Property Custodian ___________________________ Date: __________________

Approved and clearance granted:

_________________________________
Principal
______________________________________________________________________________________________

San Gabriel Elementary School, Macabebe East District

Macabebe Pampanga