Republic of the Philippines

Department of Education
Region IV – A CALABARZON
Division of Rizal
CARLOS “Botong” V. FRANCISCO MEMORIAL NATIONAL HIGH SCHOOL
Mahabang Parang, Angono, Rizal

Date: ________________________ Control No. ___________

CARLOS “Botong” V. FRANCISCO MEMORIAL NATIONAL HIGH SCHOOL

EQUIPMENT BORROWER’S FORM

Name of Borrower: _Ricah Lee P. LEQUIN____________Date Borrowed : ___________

Type of Equipment to be borrowed: (Please check one)
•  Laptop  Projector // CPU/Monitor  Printer
• Other: ( pls. specify )__mouse, keyboard, 2 power cord, Lan cable, headset, VGA cable
Expected Date of Return: When face to face class is allowed Serial No.__________ Property
Number_____________

Purpose:

1._School paper works, online teaching_________________________________________________.

2. __________________________________________________________________________________
Agreement:
1) I hereby agree to the full accountability on the use and care of the said equipment. including its part and peripherals until it has
been returned.
2) I hereby agree to exercise appropriate care in using and securing the equipment and shall not allow any unauthorized person to
borrow and use the same.
3) I hereby agree to return the above equipment complete with all its parts and peripherals at the specified date in good working
condition.

Prepared by: Approved by:

_________________________________
ICT COORDINATOR
_________________________________ ___NENITA N. DE LEON________
SCHOOL PROPERTY CUSTODIAN/ SCHOOL HEAD/AUTHORIZED PERSONNEL
AUTHORIZED PERSONNEL

Received by:

__RICAH LEE P. LEQUIN_________

BORROWER

__________________________________________________________________________________________
Address: Apple st. Grand Valley Subdivision Phase IV, Mahabang Parang, Angono, Rizal
Telephone No: JHS- 09171545675
Email Address: cbvfmnhs.301433@deped.gov.ph
Website: https://cbvfmnhs301433.wixsite.com/website
 Republic of the Philippines
Department of Education
Region IV – A CALABARZON
Division of Rizal
CARLOS “Botong” V. FRANCISCO MEMORIAL NATIONAL HIGH SCHOOL
Mahabang Parang, Angono, Rizal

__________________________________________________________________________________________
Address: Apple st. Grand Valley Subdivision Phase IV, Mahabang Parang, Angono, Rizal
Telephone No: JHS- 09171545675
Email Address: cbvfmnhs.301433@deped.gov.ph
Website: https://cbvfmnhs301433.wixsite.com/website