ENGLISH- Grade 5

Student’s Name: Grade / Section:

__________________________________ __________________________________
Teacher: Date Submitted:
__________________________________ __________________________________

I. LEARNING SKILLS

MELC: Fill-out forms accurately (school forms, deposit and withdrawal

slips, etc.) EN5WC-IIj-3.7

Objectives:
● Follow directions in filling out forms
● Fill out forms accurately (school forms, deposit and withdrawal slips, etc.)

II. INTRODUCTORY CONCEPT

III. ACTIVITIES

A. Practice Tasks
Task 1 Choose It Right!
A. Fill out the form with the needed data. Choose from the given options. Write
only the letter of the correct answer.

RO_English_Grade 5_Q1_LP1 1
 Marites Reyes Bergon lives in Zone 2 San Roque, Tabaco City, Albay. She was born
on March 9, 2007 in Amando Cope Hospital, Tabaco City. Now applying for a library card,
she needs to fill out the form to get one and use the books in the library in Tabaco National
High School.
LIBRARY CARD APPLICATION FORM

Name: Age: Sex: (Check)

1. (Last Name Given Name Middle Initial) 2. Male
Female

Address: Birthdate Citizenship

3. (No. Purok/ Zone Barangay Town/City 4. (year/day/month)

Province)

School: 5. Religion Height Weight

(meters (kg.)
)

Print ALL Entries in Capital Letters

1. A. MARITES R. BERGON B. BERGON MARITES R. C. Bergon Marites R.

2. A. 13 YRS. OLD B. 14 YRS. OLD C. 16 YRS. OLD
3. A. AMANDO COPE HOSPITAL TABACO CITY
B. ZONE 2 SAN ROQUE TABACO CITY ALBAY
C. ZONE 2 TABACO SAN ROQUE CITY, ALBAY
4. A. MARCH 9, 2007 B. 9, 2007 MARCH C. 2007 9 MARCH
5. A. TABACO NATIONAL HIGH SCHOOL
B. Tabaco National High School
C. LEGASPI CITY SCIENCE HIGH SCHOOL

Task 2 Your Turn

A grade 5 enrollee, Alexander, will be filling out a Bio–Form. Here are bits of
important information about him:

Alexander Buendia Valle, a Muslim, is enrolling as grade 5 pupil in Pawa Elementary

School. He lives in Zone 2 Pawa, Tabaco City, Albay. He was born on February 28, 2011 in
Ziga Memorial District Hospital Tabaco City, Albay.

Help him fill out the form below.

Bio-Info

Name: Age: Sex: (Check)

(Last Name Given Name Middle Male

Initial)

RO_English_Grade 5_Q1_LP1 2
 Female

Address: Birthdate Citizenship

(No. Purok/ Zone Barangay

(year/day/month)

Town/City Province)

School: Religion Height Weight

(meters) (kg.)

Task 3

Save It! Let’s pretend you will deposit an amount of P3,450.00 from INTERBANC on May 5,
2020. Show how you complete the form using the information below.

Your account number-----------3890-4629-51

Amount deposited-------------- P 3,450.00

Denomination Breakdown:

1,000.00 - 2 pcs. 500.00 - 2 pcs. 100.00 - 4 pcs. 50.00 - 1 pc.

Print entries and check the appropriate box.

INTERBANC Cash Deposit Slip

(This serves as your official receipt once validated)

Savings Current Others____________

Peso Dollar Other

Currency__________

Account Name Date

Account No.

Total amount to be deposited in words Figures

Denomination Pieces Amount

P1000.00

RO_English_Grade 5_Q1_LP1 3
 500.00

200.00

100.00

50.00

20.00

10.00 coin

5.00

1.00

Total

B. Assessment

RO_English_Grade 5_Q1_LP1 4
IV. SCORING RUBRIC
(not applicable)

V. REFLECTIONS/COMMENTS/SUGGESTIONS
Finish me Up!
1. The lesson deals with______________________________________________
2. I find it____________________________________because_______________
_________________________________________________________________
_________________________________________________________________
3. It could have been more interesting if__________________________________
_________________________________________________________________

VI. REFERENCES
English for You and Me Language Gr. 6 2008 p.165-168
DepEd-BEAM Distance Learning Program Modules 64.65.66
Daily Lesson Plan (DLP) RV rade 5 , Quarter 2 Week 10

Prepared by:

RAMON AGUILAR, MT1, TNWCS

Tabaco City Division

Layout Artists:
JOY B. JARLEGO, Teacher III, TSCES
VANESSA B. BELLEN, San Ramon ES

Quality Assurance Team:

ARLINE B. LUGO –PSDS

CRISTINA MARIE C. BORROMEO-PI, Oras ES

ASTERIA A. VELASCO-MT1, TNHS

LANY M. ABAINZA – EPS, English

Tabaco City Division

LIZA P. ARROYO- MT1, ICS

CLAUDIA MARILOU S. MARPURI- EPS, English

SDO-IRIGA CITY

RO_English_Grade 5_Q1_LP1 5
VII. ANSWER KEY
Task 1 Choose It Right
1. A 2. B 3. C 4. C 5. A
Task 2 Your Turn
Bio-Info

Name: Valle Alexander B Age: Sex: (Check)

(Last Name Given Name Middle Initial) 9 Male

Female

Address: Zone 2 Pawa Tabaco City Birthdate Citizenship

(No. Purok/ Zone Barangay Town/City 2011 28 Feb. Filipino

Albay (year/day/
month)
Province)

School: Pawa Elementary School Religion Height Weight

Islam (meters) (Kg.)

Task 3 Save It!

Print entries and check the appropriate box
INTERBANC Cash Deposit Slip

(This serves as your official receipt once validated)

Savings Current Others

RO_English_Grade 5_Q1_LP1 6
 Peso Dollar Other Currency__

Account Name Date

May 5, 2020

Account Number

3 8 9 0 4 6 2 9 5 1

Total amount to be deposited in words Figures

Three thousand four hundred fifty pesos only Php3,450.00

Denomination Pieces Amount

P1000.00 2 Php2,000.00

500.00 2 1,000.00

200.00

100.00 4 400.00

50.00 1 50.00

20.00

10.00 coin

5.00

1.00

Total Php 3,450.00

RO_English_Grade 5_Q1_LP1 7