Reason for Clearance
a. Completion
b. Transfer
Name of Student: _______________________________
Learner Reference Number: _______________________
Year and Section: ______________
Contact Number: _______________
I hereby certify that I have submitted the necessary requirements and accounted for all
property responsibility which are required of me to persons concerned:
Subject
Teacher Name
Signature
Remarks
Designated Guidance Counselor
Librarian
Property Custodian
Science Laboratory
ICT Laboratory/School ID
____________________________
Student Signature
(Signature Over Printed Name)
_____________________________
Adviser
(Signature Over Printed Name)
BEDILLA B. NAVELGAS
Principal III
DOROTEO S. MENDOZA SR. MEMORIAL NATIONAL HIGH SCHOOL
Office Address: Pagkakaisa, Naujan, Oriental Mindoro
Email Address: 301630@deped.gov.ph