School Form 3 (SF3) Books Issued and Returned

(This replaces Form 1 & Inventory of Textbooks)

School ID 116906 School Year 2020 - 2021

School Name Lagoc Elementary School Grade Level Grade 4

Araling Panlipunan, Araling Panlipunan Edukasyon sa Pagpapakatao, Edukasyon sa English, English LM Filipino, Yaman ng Lahi Music and Arts, Musika at Sining PE and Health, Edukasyong Mathematics, Mathematics LM Science, Science LM
LM Pagpapakatao LM Pangkatawan at Pangkalusugan LM
NAME
No
(Last Name, First Name, Middle
.
Name) Date Date Date Date Date Date Date Date
Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued Returned Issued

1 BAYNOSA,REYJUNE, BLANCO 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021

2 CAÑETE,JOHNNY, - 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021

3
CAPADA,JACKEBOY, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021
CABALIDA

4 CLARO,KHLIS, - 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021

5
COGONON,DAN JERYL, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021
PANOGAN

6 DINEROS,JERNEL, MAG-ASO 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021

7
ESPLAGUERA,CHRIS 1/1/2021 5/7/2021 1/1/2021 07/0/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021
LAURENCE, DENAPO

8
REPUELA,CHRISBEN, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021
UGDAMIN

9 RICO,JERON, PACHECO 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

10 RICO,JOREX, FLORES 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

11 TIGAS,JOEMARDY, ESPADILLA 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

12 TIHUME,JOVEN, BAYOTAS 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

13
TRINIDAD,ROLAND JHON, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021
DEIRIO

14 YORPO,VAN LENARD, - 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

14
<=== TOTAL FOR MALE | 4 4 9 9 7 7 7 7 8 8 7 7 7 7 7
TOTAL COPIES ===>

1
CABALIDA,JANNA AIRA, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021
PLANAS

2 CARDIENTE,ROSE, TIPDAS 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021

3
CAROMAYAN,JILLIAN MAE, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021
GEMARANGAN

4
CORBETA,NIÑA JANE, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021
TRINIDAD

5
EMPINADO,ANGEL MAE, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021
CATAPAN
e4 Section A
Science, Science LM EPP/TLE, EPP LM Subject Area & Title /
Module / Reference /
Code
REMARKS/ACTION TAKEN
(Please refer to the legend on last
page)
Date Date Date
Returned Issued Returned Issued Returned

1/1/2021 5/7/2021

1/1/2021 5/7/2021

1/1/2021 5/7/2021

1/1/2021 5/7/2021

1/1/2021 5/7/2021

1/1/2021 5/7/2021

1/1/2021 5/7/2021

5/7/2021

5/7/2021

5/7/2021

5/7/2021

5/7/2021

5/7/2021

5/7/2021

7 7

1/1/2021 5/7/2021

1/1/2021 5/7/2021

1/1/2021 5/7/2021

5/7/2021 1/1/2021 5/7/2021

1/1/2021 5/7/2021
 6 ERA,ELA MAE, SIBLAG 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

7 GAYOLA,AIZA, GACITA 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

8
JAMAYBAY,ROVELYN, 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021
BAYNOSA

9 SECRETARIA,CHARICE, YORPO 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

10 SITON,JENMIE, TRINIDAD 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

11 UGDAMIN,MAEJEL, CATAPAN 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

12 YORPO,PEARL, REQUERO 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

13 YORPO,RABEL, ABELLANO 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021 5/7/2021 1/1/2021

13
<=== TOTAL FOR FEMALE | 7 7 4 4 7 7 6 6 7 7 6 6 5 5 9
TOTAL COPIES ===>

27
<=== TOTAL LEARNERS | 11 11 13 13 14 14 13 13 15 15 13 13 12 12 16
TOTAL COPIES ===>
Prepared By:
GUIDELINES: In case of lost/unreturned books, please provide information with the following code:

1. Title of Books Issued to each learner must be recorded by the class adviser.
2. The Date of Issuance and the Date of Return shall be reflected in the form.
3. The Total Number of Copies issued at BoSY shall be reflected in the form.
4. The Total Number of Copies of Books Returned at the EoSYshall be reflected in the form.
5. All textbooks being used must be included. Additional copies of this form may be used if needed.
A. In Column Date Returned, codes are: FM=Force Majeure, TDO: Transferred/Dropout, NEG=Negligence
B. In Column Remark/Action Taken, codes are: LLTR=Secured Letter from Learner duly signed by parent/guardian (for code FM), TLTR=Teacher prepared letter/report duly
noted by School Head for submission to School Property Custodian (for code TDO), PTL=Paid by the Learner (for code NEG). References: DO#23, s.2001, DO#25, s.2003,
V
DO#14, 2.2012.

Date of BoSY:___/___/_____
 5/7/2021 1/1/2021 5/7/2021

5/7/2021 1/1/2021 5/7/2021

5/7/2021 1/1/2021 5/7/2021

5/7/2021

5/7/2021

5/7/2021

5/7/2021

5/7/2021

9 8 8

16 15 15

red By:

VIRGINIA EMPINADO TANQUE

(Signature of Adviser over Printed Name)

Generated thru LIS

f BoSY:___/___/_____ Date of EoSY: ___/___/_____