Republic of the Philippines

Department of Education
REGION IX
SCHOOLS DIVISION OF DAPITAN CITY

Form A (to be filled up by the Class Adviser)

LIST OF BENEFICIARIES OF ORAL HEALTH KITS

School Dental Care Program

School: TAG-ULO ELEMENTARY SCHOOL Date: MARCH 9, 2022

Grade Level: 3

No. of Toothbrush No. of ml of Toothpaste

Name of Learners Date Received Signature
Received Received
1.ABAD, IAN KENT R. 1 62.5ml

2.AYSON, HAROLD JAMES A. 1 62.5ml

3.BALANAY, JHON FLOUVIENS P. 1 62.5ml

4.BANUA, JHON DALTON B. 1 62.5ml

5.BAROY, ROGIE D. 1 62.5ml

6.CAMANSE, JUSTIN DAVE I. 1 62.5ml

7.ELOPRE, RAJO GABRIEL 1 62.5ml

8.GALLEPOSO, GILMAR C. 1 62.5ml

9.SUMALPONG, CEDRICK SHANE S. 1 62.5ml

Address: Sunset Boulevard, Dawo, Dapitan City
Telephone No.: (65) 908-8242 Fax No.: (65) 908-8361
Website: www.depeddapitan.net Email Address: dapitancity@deped.gov.ph
 Republic of the Philippines
Department of Education
REGION IX
SCHOOLS DIVISION OF DAPITAN CITY

10.ABAD, LUYCE ANTONETTE G. 1 62.5ml

11.BENOLIRAO, ALTHEA K. 1 62.5ml

12.CAMANSE, RHIAN B. 1 62.5ml

13. CARBONILLA, GENLOVELYN GRACE Y. 1 62.5ml

14. CARUZCA, HANNAH GRACE B. 1 62.5ml

15.CATILOC, JEZAMAE 1 62.5ml

16.CATILOC, JOAINY D. 1 62.5ml

17.CEPRADO, KAYE S. 1 62.5ml

18.CORPIN, RENZYL FE O. 1 62.5ml

19.ENOY, LAILA C. 1 62.5ml

20.TINAMBACAN, CHARLYN GLAZE B. 1 62.5ml

MILA R. VELASCO ALEX C. SAPUAN

Class Adviser HT-3

Address: Sunset Boulevard, Dawo, Dapitan City

Telephone No.: (65) 908-8242 Fax No.: (65) 908-8361
Website: www.depeddapitan.net Email Address: dapitancity@deped.gov.ph