Republic of the Philippines

Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

September 28, 2021

The School Principal/Registrar

_____________________________
_____________________________
_____________________________

Sir/Ma’am:
Please furnish as the official School Form 10/Form 137 of the following student/s who
is/are temporarily enrolled in this institution.

NAME OF LEARNER SCHOOL YEAR ATTENDED GRADE LEVEL

We appreciate favorable action with our request.

_____1ST REQUEST
_____2ND REQUEST
_____3RD REQUEST
_____URGENT

Very truly yours,

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!
 Republic of the Philippines
Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

JOE MARK D.
MANALANG
Class Adviser/LIS
Coordinator

DR. OSCAR D. GATCHALIAN

School Principal

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!
 Republic of the Philippines
Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

__________________

The School Principal/Registrar

_____________________________
_____________________________
_____________________________

Sir/Ma’am:
In compliance with your school’s policy, we are making written request of School Form
10/ Form 137 of the following learner who is temporarily enrolled in this institution.

NAME OF LEARNER SCHOOL YEAR ATTENDED GRADE LEVEL

We apologize for it took sometime from our end to make this written request since we
mistakenly assumed that the system notification from LIS is suffice to facilitate the transfer of
learners’ documents as instructed from DepEd Order 54, s.2016, Guidelines on the Request and
Transfer of Learner School Record specifically Section V, par. E that says “The LIS shall be used
as platform in the request and transfer….”
We appreciate favorable action with our request.
_____1ST REQUEST
_____2ND REQUEST
_____3RD REQUEST
___⁄__URGENT
Very truly yours,
________________________
Class Adviser

DR. OSCAR D. GATCHALIAN

School Principal II

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!
 Republic of the Philippines
Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

CERTIFICATION

This is to certify that FAMKEE B. ROMERO is a Grade 9- STE NEPTUNE of this

school, SY 2021-2022.

This further certifies that she is of good moral character and has no derogatory
record in this school.

This certification is issued upon his request for all legal intents and purposes
this 3rd day of February, 2022.

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!
 Republic of the Philippines
Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

DR. OSCAR D. GATCHALIAN

School Principal II

School Seal

CERTIFICATION

This is to certify that DANIELLE BELLE M. BALDERAS is a Grade 10 STE -

JUPITER of this school, SY 2021-2022.

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!
 Republic of the Philippines
Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

This further certifies that she is of good moral character and has no derogatory
record in this school.

This certification is issued upon her request for all legal intents and purposes
this 9th day of February, 2022.

DR. OSCAR D. GATCHALIAN

School Principal II

School Seal

CERTIFICATION

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!
 Republic of the Philippines
Department of Education
Region I – Ilocos Region
La Union Schools Division Office
President Elpidio Quirino National High School
San Agustin East,Agoo, La Union

This is to certify that GABRIELLE ALNICA C. BALDERAS is a Grade 10 STE-

JUPITER of this school, SY 2021-2022.

This further certifies that she is of good moral character and has no derogatory
record in this school.

This certification is issued upon her request for all legal intents and purposes
this 9th day of February, 2022.

DR. OSCAR D. GATCHALIAN

School Principal II

School Seal

President Elpidio Quirino National High School

San Agustin East, Agoo, La Union
(072) 687-0599 / peqnhsagoo@gmail.com …….where future leaders
grow!