Republic of the Philippines

Department of Education
National Capital Region
Schools Division Office of Caloocan City
Bagong Barrio National High School
M. De Castro Street, Barangay 142, Bagong Barrio, Caloocan City

The Principal/Registrar

BAGONG LOTE ES__________

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Sir/Madam:
Please furnish this office the Permanent Record ( Form 137-A or School Form 10) with their
Learner’s Reference (LRN) of the student herein-listed who has been temporarily enrolled in this school
upon presentation of their transfer admission Credentials.
NAME YEAR & SECTION CURRICULUM YEAR
LUCENA, SHANTA LOREINE PEREZ GRADE 6 – AMETHYST 2022-2023

As per D.O. #58 s.2017 RE: Adoption of New Forms For Kindergarten, JHS, SHS, ALS, Health
1st Request___✓___ & Nutrition & PERMANENT RECORDS, if the learner TRANSFERRED OUT to continue to
another JHS, the ORIGINATING SCHOOL upon receipt of a written request or system
2nd Request________ notification of transfer through the LIS, whichever comes first, will create one certified true
3rd Request________ copy of SF10-JHS for their file and SEND THE ORIGINAL SF10 with the OTHER PERTINENT
DOCUMENT such as birth certificate ; Elem. F137 and other proof of learners and eligibility
to the receiving school.
Urgent Request___✓___ NOTE: Please do not write anything on the box intended for the receiving school’s data.
Please entrust to the bearer___________

Note: NOT VALID WITHOUT THE SCHOOLSEAL

If there is no available school seal please indicate a note
and kindly affix your signature MARIA CINDI V. CALDERON
Teacher/Registrar

Address: M. De Castro Street, Barangay 142, Bagong Barrio, Caloocan City

Telephone Number: 8-277-2002
Email Address: bbnhs1979@gmail.com