Republic of the Philippines

Department of Education
Region V
SCHOOLS DIVISION OFFICE OF CAMARINES SUR

ACKNOWLEDGEMENT RECEIPT

Name of School: __________________________________________________

School Address: __________________________________________________
Name of School Head: _____________________________________________
Grade Level: _____________________________________________________
Class Adviser: ____________________________________________________
Total No. of Pages: ________________________________________________

This is to acknowledge receipt of the SLM/LAS from SDO Camarines Sur for the
School Year 2020-2021.

Name of Recipient Student Received by Relationship to Recipient Signature

Prepared by:
____________________________________
Signature Over Printed Name of Class Adviser

Address: Freedom Sports Complex, San Jose, Pili, Camarines Sur

Email: deped.camsur@deped.gov.ph
Website: www.depedcamsur.com
Telephone No.: (telefax) 8713340