Republic of the Philippines

DEPARTMENT OF EDUCATION
CARAGA Administrative Region
Schools Division Office of Surigao City
Surigao City District IV
CLEMENTINO V. DIEZ MEMORIAL CENTRAL ELEM. SCHOOL
Roxas Street, Brgy. Washington, Surigao City
School ID 132290

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Sir/Madam:

Please furnish us with the original copy of the Learner Permanent Record for Elementary School
(SF10-ES) Formerly Form 137 of the following pupil/s who have been temporarily enrolled in our school
upon presentation of his/her credentials which show that he/she studied in your school and are/is eligible for
transfer and admission.

NAME OF PUPIL School Year last attended in Grade Level /Adviser Grade in our School/
your School School Year

The bearer is authorized to hand carry the said request.

 NOTE:
( ) 1stRequest
( ) 2ndRequest Very truly yours,
( ) 3rdRequest
( ) Urgent 

NELSON F. HADJI
Principal III