Name of AO: Date:

Time Arrival: Time Out:

No. Name Time In Payment Signature CBU Withdrawals

Amount Signature
1. ABUEVA, MELITA
2. AGUADO, AIDA
3. AMIGO, MARY JEAN
4. BAGUIO, ROSEMARIE
5. BERNAS, TERESITA
6. BOHOL, JOVILYN
7. CABATINGAN, CONCORDIA
8. CABRERA, JONATHAN
9. CAPIN, ANGELITA
10. CELEDONIO, PRESILIANO
11. COLOT, JUDITH
12. DECHAVEZ, LETTY
13. DECHAVEZ, ALBERT
14. DOLIENTE, JANE
15. ESGUERRA, ANALIE
16. ESGUERRA, SANCHO JR.
17. ESPEJON, CHARLIE
18. HALASAN, ETHEL
19. HERNANDEZ, EVA
20. HERNANDEZ, ROSA
21. IMPAS, MICHAEL
22. IMPAS, LYDIA
23. IMPAS, MARY JANE
24. JANDAYAN, ADELINA
25. LABAJO, RUTH
26. LARANJO, ANABELLE
27. LARANJO, RENATO JR.
28. LEONIDAS, AURELIA
29. LUNA, ESTRELLA
30. MANON-OG, ELIZABETH
31. MANON-OG, RICARDO
32. MANSING, GERAMIE
33. MANSING, RICARDO JR.
34. MATUTINA, ESTER
35. MATUTINA, EFIGENIO
36. OJENDRAS, CRISTINO
37. PAYOT, TRINIDAD
38. PELARINA, JANET
39. PLEÑOS, JEREMIAS
40. RANARIO, TENEE
41. REQUINIO, EMELYN
42. REDULLA, JOSEPHINE
43. REYES, FLORENCIA
44. ROBARO, NAYSE JOY
45. ROBEBE, ERIC
46. SABLAS, ELEONILA
47. SABLAS, VIRGILIO
48. SACAYAN, ARLENE
49. SACAYAN, EUFEMIO
50. SEGUNDO, ANALYN
51. TAPINIT, ELDIZA
52. VERDEFLOR, MENCHU
53. VERDEFLOR, GRACELYN
54. WENCESLAO, DIOSCORA
55. WENCESLAO, NERSON
56.
57.
58.
59.
60.
Gross Total: Total Withdrawal: