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Department of Education

Region VI Western Visayas


Division of Negros Occidental
District of Murcia I
DON A. R. MONTELIBANO ELEMENTARY SCHOOL
Had. Binitin, Brgy. Blumentritt, Murcia, Negros Occidental 6129

The Principal
__________________
__________________
__________________

Sir/Ma’am:

Kindly furnish us with the Permanent Record (Form 137 E) of the pupil/s listed below who
has/have been admitted in this school upon presentation of his/her Form 138 A/Certification/Transfer
credentials.

Name of Pupils In your school In our school Teacher

Note: In the event that the form 137 E of the above stated pupil/s cannot be forwarded, please inform us
accordingly. Please disregard this request if the same has been complied.

__________1st Request
__________2nd Request Urgent
__________3rd Request, please entrust to the bearer
Thank you…

_______________________________
Class Adviser

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