Republic of the Philippines

DEPARTMENT OF EDUCATION
Region III –Central Luzon
Division of Nueva Ecija
District of Carranglan

Bunga Integrated School

Brgy. Bunga, Carranglan 3123, Nueva Ecija
e-mail address: bunga.integratedsch@yahoo.com

STUDENT CLEARANCE
TO WHOM IT MAY CONCERN:

This is to certify that I have accounted for all money and property
responsibilities for which I am accountable this School Year 2012-2013 as shown by
the signature below.

Remarks Remarks
Birth Certificate ______ HPTA ______
Form 138 ______ Misc Fee
Form 137 ______

________________________
Signature over Printed Name
________________________
Recommending Approval: Grade/Year and section

__________________________________
Signature over Printed Name of Adviser Approved:

WILSON M. BIER
School Principal I

STUDENT COPY

Republic of the Philippines

DEPARTMENT OF EDUCATION
Region III –Central Luzon
Division of Nueva Ecija
District of Carranglan

Bunga Integrated School

Brgy. Bunga, Carranglan 3123, Nueva Ecija
e-mail address: bunga.integratedsch@yahoo.com

STUDENT CLEARANCE
TO WHOM IT MAY CONCERN:

This is to certify that I have accounted for all money and property
responsibilities for which I am accountable this School Year 2012-201 as shown by
the signature below.

________________________
Signature over Printed Name
________________________
Recommending Approval: Year and section

__________________________________
Signature over Printed Name of Adviser Approved:

WILSON M. BIER
School Principal I
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region III –Central Luzon
Division of Nueva Ecija
District of Carranglan

Bunga Integrated School

Brgy. Bunga, Carranglan 3123, Nueva Ecija
e-mail address: bunga.integratedsch@yahoo.com