English

Quarter 1 – Module 1
Filling Out of Forms
English – Grade 5
Quarter 1 – Module 1: Filling Out of Forms

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Such agency or office may, among other things, impose as a condition the payment of
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Borrowed materials (i.e., songs, stories, poems, pictures, photos, brand names,
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Every effort has been exerted to locate and seek permission to use these materials from
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ownership over them.

Regional Director: Gilbert T. Sadsad

Assistant Regional Director: Jessie L. Amin

Development Team of the Module

Writer: Ramon Aguilar
Editor: Lany M. Abainza
Reviewer: Jily L. Roces
Illustrator: Jason C. Borabo
Layout Artist: Catherine B. Panti
 MODULE 1: Lesson 1
Filling Out of Forms

Good day my dear student. I am Teacher Corry, your teacher in this modular
teaching and learning. I’m glad to have you as my student. I hope you will learn
and enjoy in the different lessons in Grade 5.

Are you ready for your first lesson?

Come, have fun and adventure in learning with me.

Transactions, businesses, schooling and most importantly

applying for jobs ask for accurate information through forms. Error in
filling out of data would give an impression that we do not understand
the questions in the form or we lie or falsify information. It is a must
that everyone should know how to fill out forms correctly.

In this module, you will learn how to fill out forms accurately
through series of activities which you will be answering.

Objectives:

At the end of this module, you are expected to

1. tell the importance of filling out forms correctly
2. fill out forms accurately (school forms, deposit and withdrawal slips, etc.)
3. follow directions in filling out forms
This

YOUR READINESS CHECK

A. Choose the letter of the entry that should appear in the form as what is stated in
the paragraph. Write only the letter of the answer.

Marites Reyes Bergon lives in Zone 2 San Roque, Tabaco City, Albay. She was born
March 9, 2007 in Amando Cope Hospital Tabaco City. Now applying for a library card, she
needs to fill out the form to get one and use the books in the library in Tabaco National High
School.

LIBRARY CARD APPLICATION FORM

Name: Age: Sex: (Check)

1. (Last Name Given Name Middle Initial) 2. Male
Female

Address: Birthdate Citizenship

3. (No. Purok/ Zone Barangay Town/City 4.
(year/day/month)

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 Province)
School: 5. Religion Height Weight
(meters) (kg.)

Print ALL Entries in Capital Letters

1. A. MARITES R. BERGON B. BERGON MARITES R. C. Bergon Marites R.

2. A. 13 YRS. OLD B. 14 YRS. OLD C. 15 YRS. OLD
3. A. AMANDO COPE HOSPITAL TABACO CITY
B. ZONE 2 SAN ROQUE TABACO CITY ALBAY
C. ZONE 2 TABACO SAN ROQUE CITY, ALBAY
4. A. MARCH 9, 2007 B. 9, 2007 MARCH C. 2007 9 MARCH
5. A. TABACO NATIONAL HIGH SCHOOL
B. Tabaco National High School
C. LEGASPI CITY SCIENCE HIGH SCHOOL
(See Answer Key on the last page)

How did you do in the readiness check? If you got 5-4, congrats!
But if you got 3 below, do not worry. This module will help
improve further your skill in filling out of form. Good luck.

YOUR VOCABULARY BUILDER

Below are words which you will meet as you go along this module.
Choose the appropriate word to fit the given meaning.

PAYEE TRANSACTION DENOMINATION CITIZENSHIP FORM

1.____________- is a printed or typed document with blank spaces for

insertion of required information, such as full name, (surname, first name, middle
name), birthdate and address

2.______________-the often published record of the meeting, a business deal , a

communicative action or activity

3. _____________ - membership in a community, the state of being a citizen

4.______________________- one to whom money is to be paid

5. ______________________- the value or size of a series of values (as of money)

(See Answer Key on the last page)

YOUR INITIAL TASK

There are 2 Bio-Info Forms filled out with the needed data below.

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 The Bio-Form is for Maria Grageda Tucson, a resident of Purok 2 Brgy. Marikit,
Marinduque. She is a 20 year old management graduate of Marinduque University. She was
born August 12, 2000 in Marinduque General Hospital. She weighs 43 kilos and stands at
153 centimeters.

Choose the Bio-Info form which was correctly filled out. Write only the letter
of the answer.
Bio-Info Form A
Print ALL Entries in Capital letters.
Applicant’s Bio-Info
Position: SUPERVISOR
Name: TUCSON MARIA GRAGEDA Age: 20 Sex: (Check)
(Last Name Given Name Middle Name) Male
Female
Address: PUROK 2 MARIKIT MARINDUQUE Birthdate Citizenship
(no. purok/zone barangay town/city province) 2000-12-08 FILIPINO
(year/day/month)
School: Religion Height Weight
Elem. CULIAT CENTRAL ELEMENTARY (meters) (kg )
SCHOOL
Secondary: MARINDUQUE NATIONAL HIGH SCHOOL Roman Catholic 1.53 43
College: MARINDUQUE UNIVERSITY

Bio-Form B
Print ALL Entries in Capital Letters
Applicant’s Bio-Info
Position: Supervisor
Name: Grageda Maria Tucson Age: 20 Sex: (Check)
(Last Name Given Name Middle Name) Male
Female

Address: Purok 2 Marikit Marinduque Birthdate Citizenship

(no. purok/zone barangay town/city province) 8-12-2020 Filipino
(year/day/month)
School: Religion Height Weight
Elem: Culiat Central Elementary School (meters) (kg )
Secondary: Marinduque National High School 1.53 43
College: Marinduque University

Which form was correctly filled out , A or B? If you answer A, then you are correct.

What makes B erroneous? ____________________________________

Did you notice the following errors in Bio-Form B?

1. Under Last Name, the middle name was written instead

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2.The entry in Date of Birth was not arranged as stated in the form. The correct
arrangement is year, day, month and the year of birth is the present year.

3. Age doesn’t tally with the birthdate.

4. Entries were not written in capital letters as what the instruction states.

If there are errors in the Bio-Form, do you think Maria will be hired in the company as
supervisor? Why? __________________________________________________________

Now you’re aware on how to fill out forms accurately. For sure you
will be able to answer the next activities with ease. Keep working!

YOUR GUIDE

We have different forms such as bio-data, deposit and withdrawal slips, application
form, money order form, community tax certificate and many others. Though they differ in
form or style, these forms should be properly, correctly, and honestly filled out.

We should be careful not just in the information we enter in the form but also in the
instruction/direction given. Below are guides in filling out of forms.

Tips in Filling Out of Forms

1. Read the form carefully before you write anything.

2. Make sure that you keep the necessary information or complete
personal details.
3. Find out if you are asked to use block letters or block capitals.
4. Find out if there is a need to fill in everything.
5. If an item does not apply to you, leave it blank.
6. If there is an item on the form you do not understand, ask for
help/assistance.
7. Review the entries or date you have entered before submitting the form.

YOUR DISCOVERY TASKS

ACTIVITY 1. YOUR TURN

A grade 5 enrollee, Alexander, will be filling out a Bio –Form. Here are important
information about him:

Alexander Buendia Valle, a Muslim, is enrolling as grade 5 pupil in Pawa Elementary

School. He lives in Zone 2 Pawa, Tabaco City, Albay. He was born on February 28, 2011 in
Ziga Memorial District Hospital Tabaco City.

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 Help him fill out the form below.
Bio-Info

Name: Age: Sex: (Check)

(Last Name Given Name Middle Initial) Male
Female

Address: Birthdate Citizenship

(No. Purok/ Zone Barangay Town/City
(year/day/month)
Province)
School: Religion Height Weight
(meters) (Kg.)

Print all entries (See Answer key on the last page)

ACTIVITY 2. CHOOSY

Juliana Campos has just received a big amount of money from her mother Grace
Campos and she decided to deposit a portion of the money in her savings account in
InterBanc. Here are the information needed in filling out the cash deposit slip:

Account Name - Miss Juliana Campos.

Account Number - 2468-1012-14
Amount in cash to be deposited - P50,000.00
Date - March 3 ,2009
Denomination Breakdown
1,000 - 30 pcs. 500 - 28 pcs. 100 - 35 pcs. 50 - 50 pcs.

Given the data above, let me see if you can identify the correct data needed in the
deposit slip. Write only the letter of the correct choice in your answer sheet.

Print entries and check the appropriate box

INTERBANC Cash Deposit Slip

(This serves as your official receipt once validated)

1. A Savings Current C Others

B
Peso Dollar Other Currency_______

Account Name Date (3)

A. March 3, 2003
(2) A. Juliana Campos B. Grace Campos C. Not stated B. March 9, 2003
C. March 3, 2009
(4) Account Number
A 2 4 6 8 1 2 0 1 1 4
B 2 4 4 8 1 0 1 2 1 4
C 2 4 6 8 1 0 1 2 1 4
Total amount to be deposited in words Figures

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 (5) A. fifty thousand pesos (6) A. Php5,000
B. Fifty thousand pesos only B. Php500,000
C. Fifty thousand and three hundred pesos only C. Php50,000
Denomination Pieces Amount
P1000.00 (7) A. 20 B. 30 C. 25

500.00
200.00
100.00 (8) A. 3,500.00
B. 35,000.00
C. 350.00
50.00 (9) A. 50
B. 20
C. 40
20.00
10.00 coin
5.00
1.00
Total (10) A. Php 500.00
B. Php 5000.00
C. Php 50,000.00
(See Answer key on the last page)

How did you find the activities? If you got them all right, then you deserve
a . If still you made mistakes, don’t give up. Go back to that part
and analyze why you got wrong. Remember we learn from our mistakes.

ACTIVITY 3. SAVE IT

Let’s pretend you will deposit an amount of P3,450.00 from INTERBANC on May
5,2020. Show me how you complete the form using the information below. Let me
check your work when we meet.

Your account number-----------3890-4629-51

Amount deposited-------------- P 3,450.00

Denomination Breakdown:

1,000.00 - 2 pcs. 500.00 - 2 pcs. 100.00 - 4 pcs. 50.00 - 1 pc.

Print entries and check the appropriate box

INTERBANC Cash Deposit Slip

(This serves as your official receipt once validated)

Savings Current

Others______________

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 Peso Dollar Other Currency__________

Account Name Date

Account No.

Total amount to be deposited in words Figures

Denomination Pieces Amount

P1000.00
500.00
200.00
100.00
50.00
20.00
10.00 coin
5.00
1.00
Total

(See Answer key on the last page)

LET’S SUM IT UP

Filling out of form is not just entering the data in a prescribed form.
One needs to examine closely the form for instruction which may be tricky
or confusing. There are forms which are delicate that erasures will make
your transactions void or useless. At present there are forms to be
accomplished online but you need to know how to fill these out correctly
because it will be hard for you to correct it online once submitted.

YOUR FINAL TASKS

A. Read carefully the paragraph then fill out the form with the data needed.

Myrna Osami has run short of cash during her Misibis vacation in the province of
Albay. She called up her dad Zosimo Osami in Ermita Manila to send her allowance for the
remaining days of her stay in Albay. Her dad responded at once and sent her Php10, 000
thru money order form.

Let’s pretend that you are the father. Fill out the Money Order Form

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 Money Order Form

Application for Money Order Control No. ______

Date______________
Amount in Words Figure

__________________________________________________ __________________

Payee Address

Sender’s Name Address

Teller’s Signature Validated ID Presented: Date

(See Answer key on the last page)

B. Next form is a community tax certificate. Fill it out properly.

DepEd-BEAM Distance Learning Program Modules 64,65,66)

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 Congratulations! Your patience has paid off. Just remember to
be accurate in filling out of forms.

YOUR REINFORCER

A. Fill out the form with your data. Enter information legibly.

PUPIL INFORMATION SHEET

Name _____________________________________________ Birthdate_____________

(Family Name Given Name Middle Name) (Year Month
Day)
Address Nationality
_____________________________________________ Age_____ _______
(No. Street Barangay Town/City Sex M
_____________________________________________ F
Province Country (Circle the
letter)
School_________________________________________ LRN________________

Grade and Section Height Weight

____________________________________ (cm) (Kg)
Adviser______________________________

Father’s Name Occupation Email Address

Mother’s Maiden Name Occupation Contact No.

___________________________________________
Signature Above Printed Name

YOUR REFLECTION/S
What have I learned?
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

Congratulations! You made it. Keep it up in the next modules.

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 ANSWER KEY

Your Readiness Check

1. B 2. A 3. B 4. C 5. A
Your Vocabulary Builder
1. FORM 2. TRANSACTION 3. CITIZENSHIP 4. PAYEE 5. DENOMINATION
Your Discovery Task
Activity 1. Your Turn

Bio-Info

Name: Valle Alexander B Age: Sex: (Check)

(Last Name Given Name Middle Initial) 9 Male
Female
Address: Zone 2 Pawa Tabaco City Birthdate Citizenship
(No. Purok/ Zone Barangay Town/City 2011 28 Feb. Filipino
Albay (year/day/month)
Province)
School: Pawa Elementary School Religion Height Weight
Islam (meters) (Kg.)

Activity 2 Choosy
1. A 2. A 3. C 4. C 5. B
6. C 7. B 8. A 9. A 10. C
Activity 3 Save It.

Print entries and check the appropriate box

INTERBANC Cash Deposit Slip

(This serves as your official receipt once validated)

Savings Current Others

Peso Dollar Other Currency__

Account Name Date

May 5, 2020
Account Number
3 8 9 0 4 6 2 9 5 1

Total amount to be deposited in words Figures

Three thousand four hundred fifty pesos only Php3,450.00

Denomination Pieces Amount

P1000.00 2 Php2,000.00

500.00 2 1,000.00

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200.00
100.00 4 400.00
50.00 1 50.00
20.00
10.00 coin
5.00
1.00
Total Php 3,450.00

Your Final Tasks

A. Money Order Form

Application for Money Order Control No. _______

Date______________
Amount in Words Figure
Ten thousand pesos only Php10, 000.00
Payee Address
Myrna Osami Misibis, Albay
Sender’s Name Address
Zosimo Osami Ermita Manila
Teller’s Signature Validated ID Presented: Date

B. Community Tax Certificate

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References:
English for You and Me Language Gr. 6 2008 p.165-168

DepEd-BEAM Distance Learning Program Modules 64.65.66

Daily Lesson Plan (DLP) RV Grade 5 , Quarter 2 Wk 10

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For inquiries or comments, please contact:

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