Republic of the Philippines

Department of Education
Region V
SCHOOLS DIVISION OFFICE OF CAMARINES SUR
Record Section Tel. No. 871-33-57

Date Filed : ___________________

Received by : ___________________

REQUEST FOR CERTIFICATION

EUFROSINIA I. LAGDAAN
Records Officer II
DepEd-Division of Camarines Sur

Madam:

The following teachers/personnel of __________________________________________would

like to request for their (IPR (Performance Rating), as certified by their signature and purpose as stated
therein.

COMPLETE NAME DESIGNATION EMP.NO SIGNATURE

1. ___________________________ _________________ _____________ ________________
2. ___________________________ _________________ _____________ ________________
3. ___________________________ _________________ _____________ ________________
4. ___________________________ _________________ _____________ ________________
5. ___________________________ _________________ _____________ ________________
6. ___________________________ _________________ _____________ ________________
7. ___________________________ _________________ _____________ ________________
8. ___________________________ _________________ _____________ ________________
9. ___________________________ _________________ _____________ ________________
10. ___________________________ _________________ _____________ ________________
11. ___________________________ _________________ _____________ ________________
12. ___________________________ _________________ _____________ ________________
13. ___________________________ _________________ _____________ ________________
14. ___________________________ _________________ _____________ ________________
15. ___________________________ _________________ _____________ ________________

Thank you very much.

_________________________________
(SIGNATURE OVER PRINCIPAL’S NAME)
APPROVED:
CP NO: _______________

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

Email: deped.camsur@deped.gov.ph
Website: www.depedcamsur.com
Telephone No: (telefax) 8713340
 Republic of the Philippines
Department of Education
Region V
SCHOOLS DIVISION OFFICE OF CAMARINES SUR
Record Section Tel. No. 871-33-57

Date Filed : ___________________

Received by :___________________

REQUEST FOR CERTIFICATION

_____________________________
Date

EUFROSINIA I. LAGDAAN
Records Officer II
DepEd-Division of Camarines Sur

Madam:

I would like to request a copy of my (IPR(Performance Rating)),

_______________________, __________, ________ of ___________________________.

(COMPLETE NAME) (EMPLOYEE NO.) (POSITION) ( SCHOOL & DISTRICT)

It is needed for ___________________________________________________________

(PURPOSE)
_____________________________________.

Thank you very much.

__________________________
(SIGNATURE OVER PRINTED NAME)

APPROVED: CP NO: _______________

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

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