5
DIVISION OF NAVOTAS CITY
English
Quarter 1 – Module 1:
Fill -out forms accurately (school forms,
deposit and withdrawal
slips, etc.)
S.Y. 2020-2021
NAVOTAS CITY PHILIPPINES
English – Grade 5
Alternative Delivery Mode
Quarter 1 – Module 1: Fill-out forms accurately (school forms, deposit and withdrawal
slips, etc.)
First Edition, 2020
Republic Act 8293, section 176 states that: No copyright shall subsist in any work
of the Government of the Philippines. However, prior approval of the government agency or
office wherein the work is created shall be necessary for exploitation of such work for profit.
Such agency or office may, among other things, impose as a condition the payment of
royalties.
Borrowed materials (i.e., songs, stories, poems, pictures, photos, brand names,
trademarks, etc.) included in this module are owned by their respective copyright holders.
Every effort has been exerted to locate and seek permission to use these materials from
their respective copyright owners. The publisher and authors do not represent nor claim
ownership over them.
Published by the Department of Education
Secretary: Leonor Magtolis Briones
Undersecretary: Diosdado M. San Antonio
Development Team of the Module
Writers: Joana Marie C. Iglesia
Editors: Name
Reviewers: Name
Illustrator: Name
Layout Artist: Rey A. Huesca
Management Team: Alejandro G. Ibañez, OIC- Schools Division Superintendent
Buenafe E. Sabado, OIC- Asst. Schools Division Superintendent
Loida O. Balasa, Chief, Curriculum Implementation Division
Marco D. Meduranda, Education Program Supervisor in English
Grace R. Nieves, Education Program Supervisor in Charge of LRMDS
Lorena J. Mutas, ADM Coordinator
Printed in the Philippines by ________________________
Department of Education – Navotas City
Office Address:
Telefax:
E-mail Address:
BES Compound M. Naval St. Sipac-Almacen Navotas City
____________________________________________
02-8332-77-64
____________________________________________
____________________________________________
navotas.city@deped.gov.ph
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English
Quarter 1 – Module 1:
Fi l l -out forms accuratel y (school
forms, deposi t and wi thdrawal
sl i ps, etc.)
Introductory Message
For the facilitator:
Welcome to the English 5 Alternative Delivery Mode (ADM) Module on Fill-out forms
accurately (school forms, deposit and withdrawal slips, etc.
This module was collaboratively designed, developed and reviewed by educators
both from public and private institutions to assist you, the teacher or facilitator in
helping the learners meet the standards set by the K to 12 Curriculum while
overcoming their personal, social, and economic constraints in schooling.
This learning resource hopes to engage the learners into guided and independent
learning activities at their own pace and time. Furthermore, this also aims to help
learners acquire the needed 21st century skills while taking into consideration
their needs and circumstances.
In addition to the material in the main text, you will also see this box in the body of
the module:
Notes to the Teacher
This contains helpful tips or strategies
that will help you in guiding the learners.
As a facilitator, you are expected to orient the learners on how to use this module.
You also need to keep track of the learners' progress while allowing them to
manage their own learning. Furthermore, you are expected to encourage and assist
the learners as they do the tasks included in the module.
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For the learner:
Welcome to the English 5 Alternative Delivery Mode (ADM) Module Fill-out forms
accurately (school forms, deposit and withdrawal slips, etc.)
This module was designed to provide you with fun and meaningful opportunities
for guided and independent learning at your own pace and time. You will be
enabled to process the contents of the learning resource while being an active
learner.
This module has the following parts and corresponding icons:
What I Need to Know
This will give you an idea of the skills or
competencies you are expected to learn in
the module.
What I Know
This part includes an activity that aims to
check what you already know about the
lesson to take. If you get all the answers
correct (100%), you may decide to skip this
module.
What’s In
This is a brief drill or review to help you link
the current lesson with the previous one.
What’s New
In this portion, the new lesson will be
introduced to you in various ways; a story, a
song, a poem, a problem opener, an activity
or a situation.
What is It
This section provides a brief discussion of
the lesson. This aims to help you discover
and understand new concepts and skills.
What’s More
This comprises activities for independent
practice to solidify your understanding and
skills of the topic. You may check the
answers to the exercises using the Answer
Key at the end of the module.
What I Have Learned
This
includes
questions
or
blank
sentence/paragraph to be filled in to
process what you learned from the lesson.
What I Can Do
This section provides an activity which will
help you transfer your new knowledge or
skill into real life situations or concerns.
Assessment
This is a task which aims to evaluate your
level of mastery in achieving the learning
competency.
Additional Activities
In this portion, another activity will be given
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to you to enrich your knowledge or skill of
the lesson learned.
Answer Key
This contains answers to all activities in the
module.
At the end of this module you will also find:
References
This is a list of all sources used in
developing this module.
The following are some reminders in using this module:
1. Use the module with care. Do not put unnecessary mark/s on any part of
the module. Use a separate sheet of paper in answering the exercises.
2. Don’t forget to answer What I Know before moving on to the other activities
included in the module.
3. Read the instruction carefully before doing each task.
4. Observe honesty and integrity in doing the tasks and checking your
answers.
5. Finish the task at hand before proceeding to the next.
6. Return this module to your teacher/facilitator once you are through with it.
If you encounter any difficulty in answering the tasks in this module, do not
hesitate to consult your teacher or facilitator. Always bear in mind that you are
not alone.
We hope that through this material, you will experience meaningful learning
and gain deep understanding of the relevant competencies. You can do it!
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This module was designed and written with you in mind. It is here to help you
master the skills in Filling out a form. The scope of this module permits it to be
used in many different learning situations. The language used recognizes the
diverse vocabulary level of students. The lessons are arranged to follow the
standard sequence of the course. But the order in which you read them can be
changed to correspond with the textbook you are now using.
The module is divided into two lessons, namely:


Lesson 1 –Words and Phrases Commonly Used in Filling Out a Form
Lesson 2 – Guidelines in Accurately Filling Out a Form
After going through this module, you are expected to:
define commonly used words and phrases in filling out a form
2. distinguish different kinds and uses of forms
3. fill out forms accurately
4. practice and value honesty on filling out different types of forms
1.
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I.
Write TRUE if the statement is correct and write FALSE if it is not.
Write your answer on a separate sheet of paper.
1. All forms require names, birthdates, and addresses.
2. Forms may be filled out electronically or in written print.
3. Filling in a form in Block Letters or Block Capitals mean writing
everything in capital letters.
4. You can freely choose what parts you want to fill-out in a form
5. The meaning of the words sex and gender in forms are not the same.
II. Direction: Choose the letter of the best answer. Write the chosen letter on a
separate sheet of paper.
6. What does DOB stand for?
a.
b.
c.
d.
Day of Bouncing
Date of Birth
Don’t Over Book
Date of Billing
7. What is another name for surname?
a.
b.
c.
d.
Surname
Forename
Last Name
Middle Name
8. What does “Place of Birth” mean?
a. Where you study
b. Where you were born
c. Where you brought up
d. Where you go on holidays
9. What does the word “occupation” refer to?
a. Your work
b. Your work history
c. The subject you take
d. If you are married or single
10. What does the word “gender” mean?
a. Your children
b. Where you live
c. Where you were born
d. Your sex - male or female
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Lesson
1
Filling Out Forms
One of the skills learners like you will need today and in the future is how to
accurately fill out forms. These forms require information to be written and
encoded in different ways, information of which is important for you to be given
service or apply to a certain program or activity.
You in this lesson will be equipped with the knowledge on words and phrases that
are usually and commonly be found and used in different kinds of forms and skill
on accurately filling it out.
Directions: Complete the Idea Web. Write some detail or questions your teacher
usually asks you during the first day of class. An example is given to you.
my
birthdate
or birthday
Questions
usually asked by
teachers on the
first day of school
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The questions usually asked on your first day of school are also the questions you
will usually found in a form.
Was there a time when you were asked to answer something you do not know? For
example, answering a student profile form but you do not know what answer to put
on a certain line? Let me help you be familiar with forms and words commonly
contained in them.
A form is a printed or typed document with blank spaces for requested
information.
This is an example of a form.
1. Are you sure and confident
that you can fill out this form?
Yes or no? Why?
_______, because ________________
_________________________________
_________________________________
_________________________________
_______________
First name:
Contact Number
I am applying as a member of your Library
Club. I agree and swear to always follow all the
rules of the club.
I declare that all the information provided
herein are true and correct to the best of my
knowledge.
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2. Are there words in the form
that are unfamiliar to you?
Write them on the line.
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
Common Words Used in Forms and Their Definition
Words in Used in
Forms
Meaning
Example
First Name: Juan
FIRST NAME
This is also known or
called as Forename or
Given Name.
Surname: Dela Cruz
SURNAME
This is also known or
called as Last Name or
Family Name.
This is the name between
your first name and
surname.
Middle Name: Reyes
MIDDLE NAME
Usually this refers to the
last name of your mother
before being married to
your father.
It is okay if you do not
have a middle name.
Many people do not have
middle names.
MIDDLE INITIAL
ADDRESS
The first letter of your
middle name.
Juan Reyes Dela Cruz
This is where you live.
Address: #675 Rosal Street,
Tanza 1, Navotas City
You might be asked to
write it out on separate
lines.
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Middle Initial/MI: R
Street: #675 Rosal Street
Barangay: Tanza 1
Town/City: Navotas
CONTACT NUMBER
DATE OF BIRTH /
BIRTHDATE
The number of your
cellphone or telephone
that could be used to
contact you.
Contact No.: 09191234567
Do not forget to write
your specific phone area
code.
Sample Telephone Number:
This is your birthday.
When writing your
birthday, be mindful of
the year.
Date of Birth: 21st December
2010 or 21/12/2010
632 82856760
Navotas Area Code: 2
2 – 712 - 7777
Many make mistakes
about the year of their
birth.
DOB - the initials of each
word Date of Birth.
DATE
The day of signing or
filling out the form.
Date: June 12, 2020 or
12/06/2020
It is sometimes called as
“Date of Transaction”
Mr, Mrs, Miss, Ms,
Title: Mr. Juan R. Dela Cruz
Mr is used for all men
Mrs is used for a
married woman.
TITLE
Miss is used for a single
woman.
All women can use Ms.
They can be married or
single.
A unique way of writing
your first and last name
together to identify
yourself.
SIGNATURE
Your signature is unique
and must not be similar
to any people. You are
the only person in the
world who writes your
name in that way.
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Signature
If you sign a letter or
form:
● Your signature is
legally binding. Meaning,
you will be responsible
for everything you sign
● You are agreeing to the
conditions of the form.
● You are stating that the
information you are
giving is true.
OCCUPATION
This is the job you have
or the work you do.
Occupation: student
This is about your God
and group of your belief
or worship.
Religion: Catholic
RELIGION
Iglesia ni Cristo
Christian
Muslim
Born Again
Other else
PLACE OF BIRTH
SEX AND GENDER
MARITAL STATUS
This means the hospital
or the town or city you
were born in.
Place of Birth: Tondo Medical
Center / Manila City
Sex and Gender mean
the same thing. Your sex
or gender is whether you
are a man or woman,
male or female.
Sex: Male ❑ Female ❑
You may be asked to put
Married ❑
a ✔ in a box to show the
one that is right for you.
Separated ❑
Gender: Male ❑ Female ❑
Widowed ❑
Single ❑
Divorced ❑
FORM TERMS FOR BANKING PURPOSES
ACCOUNT NUMBER
This is a series of digit
specifically made for a
transaction or a person.
This is your account’s
identification number.
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Account no:
0 4 7 5 4 8 7 3 2 1
ACCOUNT NAME
DENOMINATION
This is the name of the
owner of the bill/bank
account.
Account name:
This is a proper
description of a
currency amount,
usually for coins or
banknotes.
Denomination
Juan R. Dela Cruz
Pieces
Amount
1,000
2
2,000
500
2
500
Total Amount
Php2,500
This is about the
category of values (of
your money) you are
depositing (putting in) or
withdrawing (pulling out).
MORE ABOUT FORMS
Forms need to be filled in for lots of different reasons. For example, you might want
to fill in a course or job application form. Or you might complete a form online to
order or buy something. Forms can be filled in different ways including by hand or
online.
Tips in Filling in Forms
Before filling in any
form it’s important to
be sure of the
purpose of the form
and to think about
who might read it.
You may not need to
fill in everything. If it
does not apply to you
leave it blank.
When you’re filling in
a form, read it
carefully before you
start writing.
If there is something
on the form you do
not understand, ask
for help.
.
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Check that you
understand all the
language used
and make sure
you understand
the instructions
on the form.
Make a copy of the
form so that if you
make a mistake you
can start again. You
can always ask for
an extra form to
practice on.
Guidelines in Accurately Filling Out Forms
A. BLOCK LETTERS
 Sometimes you are asked to fill a form in Block Letters or Block
Capitals. This means writing EVERYTHING IN CAPITAL LETTERS.
This is to make the information very clear and easy to read or easy to
scan by a computer.
 When you are asked to write in Block letters this does not mean your
signature. You sign your name in the usual way.
B. F
O Name: DELA CRUZ_______JUAN___________REYES__
R
MBirthdate: APRIL 12, 2020
S
WITH BOXES

When you have a form with boxes to fill in make sure to write one
letter or one number in each box.
Leave one box space between each word.

D E
L
A
C
R
U
Z
J
SURNAME
U A N
GIVEN NAME
.R
M.I
C. WRITING DATES IN BOXES
 Write one number in each box.
 Usually there are two boxes for the numbers.
 If it is a single number like 3 and 9 you have to put a 0 first to fill all
the boxes.
 Sometimes the year will be written in full – 2010
 Sometimes just the short form is used – 10
JUNE 12. 2010
1
2
/
0
6
/
2
0
1
2
/
0
6
/
1
0
1
0
D. WRITING THE ACCOUNT NAME AND NUMBER
 Write the complete name on the form. Some forms/slips will require
you to write the surname first.
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
Write one number in each box. Some forms/slips will require you to
include symbols like (-).
ACCOUNT NAME
D E
L
A
C
R
U
Z
8
8
-
J
U A N
3
1
R
.
ACCOUNT NUMBER
4
0
8
9
-
6
2
E. BREAKDOWN OF THE AMOUNT TO BE DEPOSITED OR WITHDRAW
 Write down the details asked in the form/slip including the
denominations, pieces and amount to be deposited or withdrawn.
CURRENCY
_/__PESO
___US DOLLARS
___OTHERS:____________
DENOMINATION
PIECES
Php 1,000
3
500
2
200
4
100
5
50
2
20
1
10
1
5
5
1
5
TOTAL AMOUNT
AMOUNT
3,000
1,000
800
500
100
20
10
25
5
Php 5,460
F. SIGNATURE
Forms will require you to sign your name. Your signature writing may be
done in different ways.
NAME: JUAN R. DELA CRUZ
SIGNATURE: ____________________
JUAN R. DELA CRUZ
SIGNATURE OVER PRINTED NAME
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Notes to the Teacher
Sometimes there are different types of
questions in different sections of a
form. There may be questions with a
list of possible answers and you have
to choose the answer that applies to
you. You may have to circle or tick the
right answer to a question, or cross out
the wrong answers.
Activity 1
Directions: Complete the given form by filling it out. You may seek help from
someone in your home to accomplish this.
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Activity 2
Direction: Fill-out the given form based on the given information.
1. Mang Efren O. Lacanilao, 48 is a fisherman currently living at #148 Amapola
St., Brgy Tanza 1, Navotas City. He needs to ask medical assistance from the
barangay for his asthma. Help Mang Efren fill out the Barangay Medical
Assistance Form.
BARANGAY TANZA 1 MEDICAL FORM
PLEASE WRITE IN BLOCK CAPITAL LETTERS
Date: ________________
NAME: ________________________________________________________
SURNAME
GIVEN NAME
M.I.
AGE: ________
GENDER_________
ADDRESS: ______________________________________________________________
OCCUPATION: ___________________________________________________________
MEDICAL CONDITION: __________________________________________________
Activity 2
Direction: Fill-out the given form based on the given information.
Situation: Teresa S. Santos is a grade 5 pupil at Maligaya Elementary
School. She lives at #35 Bangus Street, NBBS Kaunlaran Navotas City. She
is 10 years old. She recently won as Best Writer of The Year in an essay
writing contest held by an international organization. She needs to fill-out
the form to apply for the scholarship which is her prize for winning.
Scholarship Application Form
PLEASE WRITE IN BLOCK CAPITAL LETTERS
TITLE: __ Ms. ___Mr.
SURNAME
GIVEN NAME
M.I
ADDRESS:
NO. AND
STREET
BARANGAY
GENDER: ___MALE
CITY
___FEMALE
AGE:_____
AWARDS AND RECOGNITION: ___________________________
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EXIT SLIP
Directions: Answer the given questions. Write your answers on the line
provided below.
1. What did you learn today?
I lear ned that
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
2. Why should we be honest when filling-out forms?
_______________________________________________________
We shoul d be honest i n fi l l i ng-out for ms
_______________________________________________________
because
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
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Direction: Answer the given activity based on the given situation and information.
Situation: Your teacher has given you a task to fill-up a form as your student
profile. about your family. She asked you to get the given information by
interviewing or talking to your family members.
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Direction: Answer the given activity based on the given situation and
information.
1. Your piggy bank is already full. As you open and counted it, you just
saved:
 5 pieces of 100-peso bill,
 3 pieces of 50-pesos bill,
 10 pieces of 20-peso bill
 and 100 pieces of 1-peso coins.
Your mother decided to put your money in your Junior Savings Account
with an account number 0264-561-329. Fill out this deposit slip accurately
so you can put your money in your bank account.
RURAL BANK OF NAVOTAS
DEPOSIT SLIP
JUNIOR SAVINGS ACCOUNT
DATE: _____________________
ACCOUNT NUMBER
-
0
0
0
0
ACCOUNT NAME
____CASH
____PESO
_____CHECK
_____ US DOLLARS
DENOMINATION
1000
500
200
100
50
20
10
5
1
__ OTHERS:_____________
CASH DENOMINATION BREAKDOWN
PIECES
AMOUNT
TOTAL AMOUNT
______________________________________
SIGNATURE OVER PRINTED NAME OF DEPOSITOR
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0
During the first day of classes, your adviser usually asks you to bring this form
home to be filled out by your parent/guardian. Since you already have the
knowledge and skills in filling out forms, you can do this on your own. You may
ask one of your family members to help you fill out the data about your
parent/guardian.
Your adviser will keep this form for record purposes. A rubric will be used to check
your form.
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References
Printed Books
McKinkight, K. (2010). The Teachers’ Big Book of Graphic Organizers. San
Francisco, CA: John Wiley & Sons, Inc.
Lagoyianni,M. (2007). Understand and Use Forms. Mattoon, Illinois: Lake Land
College.
Online
BasicLifeSkillsLesson(2013).FillingOutaForm[online] Available at
https://www.osymigrant.org/Basic%20Life%20Skills%20Lessons%20%20Filling%20Out%20a%20Form.pdf
Dictionary(1828).MeaningofWordsinForms[online] Available at
https://www.merriam-webster.com/
Miller.J. (2008). Teaching Children How to Fill Out Forms.[blog version] Retrieved
from: https://fivejs.com/life-skills-for-kids-filling-out-forms/
WritingExercises(2013).FormFilling[online] Available at
http://www.literacytools.ie/files/pdfs/15%20Filling%20in%20Forms.pdf
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1
For inquiries or feedback, please write or call:
Department of Education – Schools Division Office Navotas
Learning Resource Management Section
Bagumbayan Elementary School Compound
M, Naval St., Sipac Almacen, Navotas City
Telefax:
Email Address:
02-8332-77-64
navotas.city@deped.gov.ph