STUDENT ID AutoRecovered

Republic of the Philippines Republic of the Philippines Republic of the Philippines Republic of the Philippines
DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION

DIVISION OF NEGROS OCCIDENTAL DIVISION OF NEGROS OCCIDENTAL DIVISION OF NEGROS OCCIDENTAL DIVISION OF NEGROS OCCIDENTAL
DISTRICT OF E.B. MAGALONA – CLUSTER II DISTRICT OF E.B. MAGALONA – CLUSTER II DISTRICT OF E.B. MAGALONA – CLUSTER II DISTRICT OF E.B. MAGALONA – CLUSTER II
National Highway, Brgy II Pob., E.B Magalona, Negros Occidental National Highway, Brgy II Pob., E.B Magalona, Negros Occidental National Highway, Brgy II Pob., E.B Magalona, Negros Occidental National Highway, Brgy II Pob., E.B Magalona, Negros Occidental
302621 302621 302621 302621
DELA CRUZ, JUAN A. DELA CRUZ, JUAN A. DELA CRUZ, JUAN A. DELA CRUZ, JUAN A.
11702512345 11702512345 11702512345 11702512345
MALE MALE MALE MALE
10-STARGAZER 10-STARGAZER 10-STARGAZER 10-STARGAZER

S.Y. 2022-2023 S.Y. 2022-2023 S.Y. 2022-2023 S.Y. 2022-2023
STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE
Address: Address: Address: Address:

Prk. 123456789, Prk. 123456789, Prk. 123456789, Prk. 123456789,
Brgy. 3, Brgy. 3, Brgy. 3, Brgy. 3,
E.B. Magalona, Negros E.B. Magalona, Negros E.B. Magalona, Negros E.B. Magalona, Negros
Occidental Occidental Occidental Occidental
Date of Birth:September 22, 2022 Blood Type:AB+ Date of Birth:September 22, 2022 Blood Type:AB+ Date of Birth:September 22, 2022 Blood Type:AB+ Date of Birth:September 22, 2022 Blood Type:AB+
In case of emergency, please contact: In case of emergency, please contact: In case of emergency, please contact: In case of emergency, please contact:
JUANA A. DELA CRUZ JUANA A. DELA CRUZ JUANA A. DELA CRUZ JUANA A. DELA CRUZ
09091234567 09091234567 09091234567 09091234567
Prk. 123456789, Brgy. 3, E.B. Magalona, Negros Prk. 123456789, Brgy. 3, E.B. Magalona, Negros Prk. 123456789, Brgy. 3, E.B. Magalona, Negros Prk. 123456789, Brgy. 3, E.B. Magalona, Negros
EMERGENCY HOTLINE NUMBER EMERGENCY HOTLINE NUMBER EMERGENCY HOTLINE NUMBER EMERGENCY HOTLINE NUMBER
ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR

PRINCIPAL III PRINCIPAL III PRINCIPAL III PRINCIPAL III
Republic of the Philippines Republic of the Philippines Republic of the Philippines Republic of the Philippines
DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION
DIVISION OF NEGROS OCCIDENTAL DIVISION OF NEGROS OCCIDENTAL DIVISION OF NEGROS OCCIDENTAL DIVISION OF NEGROS OCCIDENTAL
DISTRICT OF E.B. MAGALONA – CLUSTER II DISTRICT OF E.B. MAGALONA – CLUSTER II DISTRICT OF E.B. MAGALONA – CLUSTER II DISTRICT OF E.B. MAGALONA – CLUSTER II
National Highway, Brgy II Pob., E.B Magalona, Negros Occidental National Highway, Brgy II Pob., E.B Magalona, Negros Occidental National Highway, Brgy II Pob., E.B Magalona, Negros Occidental National Highway, Brgy II Pob., E.B Magalona, Negros Occidental
302621 302621 302621 302621
DELA CRUZ, JUAN A. DELA CRUZ, JUAN A. DELA CRUZ, JUAN A. DELA CRUZ, JUAN A.
11702512345 11702512345 11702512345 11702512345
MALE MALE MALE MALE
10-STARGAZER 10-STARGAZER 10-STARGAZER 10-STARGAZER

S.Y. 2022-2023 S.Y. 2022-2023 S.Y. 2022-2023 S.Y. 2022-2023
STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE
Address: Address: Address: Address:

Prk. 123456789, Prk. 123456789, Prk. 123456789, Prk. 123456789,
Brgy. 3, Brgy. 3, Brgy. 3, Brgy. 3,
E.B. Magalona, Negros E.B. Magalona, Negros E.B. Magalona, Negros E.B. Magalona, Negros
Date of Birth:September 22, 2022 Blood Type:AB+ Date of Birth:September 22, 2022 Blood Type:AB+ Date of Birth:September 22, 2022 Blood Type:AB+ Date of Birth:September 22, 2022 Blood Type:AB+
In case of emergency, please contact: In case of emergency, please contact: In case of emergency, please contact: In case of emergency, please contact:
JUANA A. DELA CRUZ JUANA A. DELA CRUZ JUANA A. DELA CRUZ JUANA A. DELA CRUZ
09091234567 09091234567 09091234567 09091234567
Prk. 123456789, Brgy. 3, E.B. Magalona, Negros Prk. 123456789, Brgy. 3, E.B. Magalona, Negros Prk. 123456789, Brgy. 3, E.B. Magalona, Negros Prk. 123456789, Brgy. 3, E.B. Magalona, Negros
EMERGENCY HOTLINE NUMBER EMERGENCY HOTLINE NUMBER EMERGENCY HOTLINE NUMBER EMERGENCY HOTLINE NUMBER
ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR

PRINCIPAL III PRINCIPAL III PRINCIPAL III PRINCIPAL III

STUDENT ID AutoRecovered

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STUDENT ID AutoRecovered

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Republic of the Philippines Republic of the Philippines Republic of the Philippines Republic of the Philippines

DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION DEPARTMENT OF EDUCATION

302621 302621 302621 302621

10-STARGAZER 10-STARGAZER 10-STARGAZER 10-STARGAZER

STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE

Address: Address: Address: Address:

ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR

302621 302621 302621 302621

10-STARGAZER 10-STARGAZER 10-STARGAZER 10-STARGAZER

STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE STUDENT’S SIGNATURE

Address: Address: Address: Address:

ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR ETHEL R. BLANCAFLOR

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