Republic of the Philippines

Department of Education
REGION IV-A CALABARZON
SCHOOLS DIVISION OF BATANGAS

PLANNING AND RESEARCH SECTION

REQUEST FORM
LIS AND EBEIS COMPLIANCE CERTIFICATE

***To be filled up by the requesting school

DATE: ____________________________

SCHOOL ID: __________________________

NAME OF SCHOOL: ________________________________________________________________________

ADDRESS: ________________________________________________________________________________

CURRICULAR OFFERING: SPED PURPOSE: RENEWAL

KINDER RECOGNITION
GRADE 1 – 6
GRADE 7 – 10
GRADE 11 – 12

Requested by:
______________________________
SIGNATURE OVER PRINTED NAME

***To be filled up by the Planning and Research personnel.

RECEIVED BY: ________________________________________ DATE: ________________

STATUS OF COMPLIANCE: LIS Compliant EBEIS Compliant

Non-Compliant Non-Compliant
Date: _________________

CHECKED AND VERIFIED: ________________________________ DATE: ________________

APPROVED FOR ISSUANCE OF CERTIFICATE: ______________________________________

ARIS U. DIMAANO
Division Planning Officer III

Date: _____________________

DEPEDBATS-PAR-F-015/R4/11-22-2021

Address: Provincial Sports Complex, Bolbok, 4200 Batangas City

(043)722-1840 / 722-1796 / 722-1437 / 722-2675 / 722-1662
deped.batangas@deped.gov.ph
www.depedbatangas.org