English 5

FIRST QUARTER
WEEK 1
WORKSHEET NO. 1

MELC:
Fill-out forms accurately
(school forms, deposit and
FILLING-OUT FORMS
withdrawal slips, etc.)
ACCURATELY
(EN5WC-IIj-3.7)

Writer: TONETTE L. ORNEDO

Illustrator: ARLENE J. BRIONES
Layout Artist: JOEY M. MATAAC
Evaluator/s: PATROCENIA M.
DEL PRADO

Department of Education • Schools Division of Marinduque

Writer:
Illustrator:
Lesson
Filling-Out Forms
1 Accurately

What’s New

A. SCHOOL FORMS

A form 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.

As a Grade Five learner, the ability to fill out forms is a skill you should be able to
develop.

Fill out a sample school form in the next pages of this worksheet. It may look like this:

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
Here are some helpful tips for filling out 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, as in AGUILAR
KYLE.
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.
7. Review the entries or date you have entered before submitting the form.
8. Avoid making erasures.
9. Handle the form with outmost care.

B. DEPOSIT SLIP

The following is a deposit slip of ONE NETWORK BANK. Study the entries.

The deposit slip above shows Julian P. Makasa’s savings account number, 49-
82625-4. Julian is depositing an amount of P1,000.00. Such amount
is comprised of 2 P 200.00 bills, 5 P100.00 bills, 1 P50.00 bill, 2 P20.00 bills, and 1
P10.00 coin.
Aside from the above-mentioned details, a deposit slip also contains the teller’s
signature. In case the depositor uses a check, he has to indicate the bank and the branch
where the check comes from, the check number, the amount and the total check deposit.

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
C. WITHDRAWAL SLIP
Another bank note is the withdrawal slip. This is used when a person wants to
withdraw money from his account in the bank.
Study the sample.

In case the depositor could not withdraw his money personally, he could ask
somebody to do it for him but he has to fill out the other page of the withdrawal slip.
Here’s how to do it.

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
 What I Can Do

Activity 1
A. Directions: Let’s pretend that you are going to enroll in Grade 7. Fill out the form accurately.
Let your teacher check your work.

Admission Form
Name:__________________ _______________________ _________________
Surname First Name Middle Name
Age: __________ Nationality __________ Sex: Male Female
Date of Birth:_____________ _________ _____
Year Month Day
Place of Birth ______________________ ______________________________
Town/City Province
Present Address:__________________________________________________
School Address:___________________________________________________
Kindergarten (if you attended one):___________________________________
Primary:___________________________________________________________
School
Intermediate:______________________________________________________
School
Parents
____________________ __________________ ______________________
Father’s Name Occupation Educational attainment
____________________ __________________ ______________________
Mother’s Name Occupation Educational attainment

_Signature over printed name Date:

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
Activity 2

Help Kanor Z. Puzon fill out the deposit

form. His account number is 33-43210-8. He will
deposit P2,500.00 only in 1 P 1,000 bill, 2 P 500.00
bill, 2 P 200.00 bill and 2 P 50.00 bill.
Date: March 5, 2021

Activity 3
Let’s pretend you withdrew an amount of P3,450.00 from ONE NETWORK BANK on
January 5, 2021. Show us how you completed the form using the information below.

Your account number-----------38-46291-5

Amount withdrawn-------------- P 3,450.00
Denomination Breakdown :
1,000.00 - 2 pcs.
500.00 - 2 pcs.
100.00 - 4 pcs.
50.00 - 1 pc.

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
 Assessment
As we grow older, we will be filling out forms of different kinds for different
transactions. It would be good to learn how to fill out forms clearly and correctly.
Complete the following forms. For checking, submit this worksheet to your teacher.
A. School Form

School _______________________________
School Year ___________________________
Name: _________________________________ Age: _________________
Address: ________________________________ Grade: ________________
Birthday: ________________________________
Birthplace: _______________________________
Name of Parents: __________________________
Father
__________________________
Mother

B. Pretend you are Mrs. Campos. Fill out the cash deposit slip using the information below.
Account Number - 2468-1012-14
Amount in cash to be deposited - P50,000
Date - March 3,2009

Denomination Breakdown
1,000 - 30 pcs.
500 - 28 pcs.
100 - 35 pcs.
50 - 50 pcs.

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
“Deped Marinduque: Heart of the Philippines
Lead to Excel, Excel to Lead”
 Additional Activity
Magno R. Regilio wants to withdraw his money in the bank. His account number is 23-
9684-7. He will deposit P 2,000.00 bill on December 6, 2009. Help him to fill out the needed
information in the slip.

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
Key to Correction
What I Can Do-

Activity 1:
Answers may vary

Activity 2

Activity 3

Assessment
A. Answer may vary

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
Assessment
B.

Additional Activities

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
 References

DepEd-BEAM Distance Learning Program Module 64

DepEd-BEAM Distance Learning Program Module 66
Kristine Erika C. Castillo and Evelyn B. Angeles. Joy in Learning, Vibal Group, Inc., 2016

Para samgakatanungan o puna, sumulat o tumawag sa:

Kagawaran ng Edukasyon – Schools Division Marinduque

T. Roque St., Malusak, Boac, Marinduque
Email: deped_marinduque@yahoo.com or
lrmds_marinduque15@yahoo.com;
Tel. No.: (042) 332-1009 / 332-1611

“Deped Marinduque: Heart of the Philippines

Lead to Excel, Excel to Lead”
“Deped Marinduque: Heart of the Philippines
Lead to Excel, Excel to Lead”