Republic of the Philippines
Department of Education
Region III
Schools Division of Angeles City
DON PEPE HENSON MEMORIAL SCHOOL
STA.TRINIDAD, ANGELES CITY
MEMORANDUM OF RECEIPT
Name of Pupil:
________________________________________________________
Grade & Section:
________________________________________________________
Class Adviser:
________________________________________________________
Name of Parent/Guardian:
________________________________________________________
Address:
________________________________________________________
________________________________________________________
Contact Number:
Item Received:
Amount:
Remarks:
Date:
________________________________________________________
USB to Go________
________________
New/Good Condition
_________________
__________________________________________________________________________________
I acknowledge receipt of the above-mentioned item with the following conditions:
1. That I have personally received the item from __________________________________________, after
reading the set conditions, and signed them to signify my agreement to it.
2. That the item shall be used for school activities during the school year.
3. That it shall be my responsibility to ensure that the item is properly maintained until it is returned to the
school administration by the end of the school year, with proof that it is in good working condition.
That in case the item is damaged, I shall replace it with the same specifications or pay the amount
equivalent to the prevailing market price of the USB.
_________________________________
Name and Signature of Parent/Guardian
Address: Sta. Trinidad, Angeles City
Email Address: donpepehenson.ms@depedangelescity.com
Republic of the Philippines
Department of Education
Region III
Schools Division of Angeles City
DON PEPE HENSON MEMORIAL SCHOOL
STA.TRINIDAD, ANGELES CITY
KASUNDUAN SA PAGTANGGING KUMUHA NG USB ON THE
GO
Pangalan ng Magulang: ___________________________________________
Pangalan ng Mag-aaral: ___________________________________________
Baitang at Seksyon: ______________________________________________
Tirahan:___________________________________________________________
_____________________________________________________________
Bilang ng Telepono: _________________________________
KASUNDUAN
Ako po ay tumatangging kunin ang USB On The Go na ibinibigay ng paaralan
na
inilalaan
sana
para
sa
pag-aaral
ng
aking
anak
dahil
________________________________________________________________.
Binibigyan ko rin ng pahintulot ang gurong tagapayo ng pangkat na ipagamit ang
USB on the go sa mag-aaral na nahuli sa pagpapatala na higit na nangangailangan
ng nabanggit na kagamitan.
__________________________________
Pangalan at Lagda ng Magulang/Guardian
Petsa: ____________________________
Address: Sta. Trinidad, Angeles City
Email Address: donpepehenson.ms@depedangelescity.com