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KATICLAN ELEMENTARY SCHOOL

DISTRICT 1 – CLUSTER 2
1ST QUARTER
SUMMATIVE TEST NO. 1
2021-2022

ENGLISH 5

NAME:___________________________________ GRADE/ SECTION: ____________ SCORE:_______

I. Fill out the form below. Complete it by using the possible answers found inside the
box. Use the form provided to you.

STUDENT PERSONAL INFORMATION

Name: ________________________________________________________________

Grade & Section: ________________________ Age: _____________ Sex: __________

Teacher: ______________________________________________________________

Address:_______________________________________________________________

Birthday:_____________________________________ Country: __________________

School: ________________________________________________________________

Royce L. Cabrera Male Ms.Rina B. Macaraig

Grade V- Maagap December 25, 2010

Catbalogan City, Samar San Roque Elementary School

Philippines

II. Fill out a withdrawal slip using the suggested information found in the box. Use the
form provided for you.

ABC BANK WITHDRAWAL SLIP

Teller’s Validation

Date: (1)_______________________ Currenncy ____Peso _____US Dollar


Prepared by:

MELISSA T. ESCANDALLO
Grade V Adviser

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