Name of School: ____________________________________ School Code: ________________ State: ___________________________
Region: ________________________________ District: _______________________________ Village: __________________________ Name of Activity: _______________________________________________________________ Activity Date: _____________________
No Book Title Level # of Books Author Publisher Remarks
Name (Stamp) Signature Date
Name of Head Teacher: ____________________________________ _________________ _______________ BAB Representative: ______________________________________ _________________ _______________ MoECHE/DEO: __________________________________________ _________________ _______________