Republic of the Philippines

Department of Education
MIMAROPA REGION
SCHOOLS DIVISION OF ORIENTAL MINDORO
DAYHAGAN NATIONAL HIGH SCHOOL
DAYHAGAN, BONGABONG, ORIENTAL MINDORO

MARIVIC G. SALMORIN, Ed.D

Principal IV
This School

Madam:

This is to inform you that I have satisfactorily settled all the property and financial obligations in the school and
that I have submitted all the required reports as listed below. May I then be granted the Year-End Clearance for
School Year 2021-2022.

In-Charge Signature Date

1. a. ) School Form 1, 2, 5 Chessa Katrina M.
b. ) School Form 138 & 137 Leido
c. ) Form 137 of Drop-Out Students
d. ) List of Students with General Average
2. Mean, MPS by Subject Myliesa M. Dagupon
3. LAC Terminal Reports Chris John G. Tenorio
4. Minutes of Homeroom PTA Meeting Luzvilla M. Cabasag
5. CS Form 48 Nerissa M. Acosta
6. Summary of Trainings/Virtual Meetings Lynnel F. Yap
Attended
7. List of Retained/Drop-Out/Transferred In and Myliesa M. Dagupon
Out/Failed/Failure due to absence (adviser only)
8. School Form Checking Report
9. Income Tax Return (BIR Form 2316) Nerissa M. Acosta
10. Library (Borrowed Books) Liezl F. Yap
11. Classroom Inventory and Room Ryan G. Gadon
Safety/Laptop/Computers
12. Financial Report/Moving Up/Graduation Rites Teacher’s Club Treasurer
13. List of Teachers undergoing graduate studies Zenaida C. Lao
14. IPCRF Roselie G.
Tenorio/Dennis Z.
Sotomayor/Gloria I. Beo
15. SALN as of December 2020/201 Files Nerissa M. Acosta
16. Tentative Enrollment Report Lynnel F. Yap

In the exigency of service, I am ___ willing/___not willing to report to work and attend Summer INSET for
teachers.

Present Home Address: _____________________________________________________________________

Cellphone Numbers: ________________________________

_____________________________________
Printed Name and Signature of Teacher

Approved and cleared granted:

MARIVIC G. SALMORIN, Ed.D

Date: ______________