Republic of the Philippines

-=:ffi Department of Education

RDGION IV-A CALABARZON
Gate 2 Karangalan Village
1900 Cainta, Rizal

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DEPED-44-01 C-RM-1 9-280
TO SCHOOLS DIVISION SUPERINTENDENTS
ATTORNEY ilt/LEGAt COORDINATORS
EPS IN-CHARGE OF PRIVATE SCHOOIS
AND PU scHooLs

FROM : Dtost SAN ANTONIO

Direc

SUBJECT: GUIDETINES IN THE CORRECTION OF ENTRIES IN IHE SCHOOL

RECORDS

DATE : Mcy 9, 2819

l. Section 5 of Republic Act No. I 1,032 entitled, Eose of Doing Business ond
Efficient Gavernmenf Service Delivery Act af 20lB provides:

Seclion 5. Reengineenng of Syslems ond Procedures. - A1l

offices ond ogencies which provide government services ore
hereby mondoted io regulorly undertoke cost complionce
onolysis, time snd motion studies, undergo evoluotion ond
improvemeni of their ironsoction systems ond procedures ond
reengineer the some if deemed necessory io reduce
bureoucrciic red tope ond processing time.

2. Considering the distonce between ond omong schools ond schools

division offices with the regionol office and the time of trovel of clients
from their respeclive residences lo lhe regioncl office, the guidelines in
securing order for correclion of school record entries is hereby issued.
The guidelines is herbto ottoched os Annex '?".

3. All memorondo inconsislent herewith ore hereby repeoled.

4. For cornplionce cnd informotion of oll.

Trunk Line: (O2) 6A2-5773 | 6A4-4914 / 647-7487

Fax: {02) 682-2Lt4
website: depedcalabarzon. ph
Facebook: DepEd R-4A Calabarzon
 Page 2 of 3

ANNEX "A'
GUIDELINES IN CORRECTION OT SCHOOL ENTRIES

l. Any person who wish to correci lhe entry/entries in his/her school

records may opply before the Legol Unit of the Schools Division Office
which hos jurisdiclion over the public or privole school which is
keeping/in custody of his/her school records"

2. The entries to be conected ore:

2.1 Nome of the opplicontt

2.2 Ploce of birth
2.3 Dofe of birth
2.4 A combinotion of two or more entries.

3. The opplicont isrequired to submit on opplicotionz indicoiing therein

the enlry/entries to be conected. Attached lo the opplicotion ore
the following requirements:

3.o Certificole of Live Birth issued by Philippine Stotislics

Authority;
3.b. Certified true copy of the Form I37 or FS 9 or
Diplomo whichever is opplicoble;
3.c. Affidovit of Two Disinterested Persons; ond
3.d. Such other documents cs moy be required by the
Attorney lll or Legol Coordinator in order to prove
the opplicotion.

4. ln cose the opplicotion is filed by the person other thon the owner of
the record, on cuthorizotion or speciol power of cttorney is required
before the processing of the cpplicotion.

5. Upon receipt of the opplicotion, the Attorney lll or Legol Coordinoior

sholl require the opplicont to fill out the data privacy ond conseni
form3.

6. The Aitorney lll oi tegot Coordinotor sholl evoluote the requirements

ottoched in the opplicotion. Helshe moy propound questions ond/or
require oiher documents which will prove to him/her lhe merits of the
opplicction.

lThis moy include correction of nome becouse of odopiion or ony legol proceedings before
the court or odministrstive ogencies.
z A scmple opplicotion is hereto ottoched os Annex "2"
a A sample dotc privccy ond consent form is hereto ottoched cs Annex "3"
 Page 3 of 3

7. ln cose the opplicotion is meritorious, he/she shollrecommend to the

Schools Division Superinlendent or in his/her obsence, the Assistont
Schools Division Superintendenl lhe gronting of the opplicotion.

8. The Schools Division Superintendent or in his/her obsence, the

Assistont Schools Division Superinlendent sholl issue on order4lo the
privote or public school to chonge the entries in the school records
of the opplicont.

9. ln cose the opplicotion is not meritorious, the Attorney lll or Legol

Coordinotor sholl inform ihe opplicolion to prove her opplicoiion by
submitting odditionol evidence. lf despite the submission of
odditionol evidence, the opplicont slill failed to prove his/her
opplicotion, the Attorney lll or Legol Coordinotor must recommend
the deniol of the opplicotion.

10.Any person whose opplicotion wos denied moy oppeol to the Office
of the Regionol Director.

+ The pro formo Order is hereto ottoched os Annex "4"

 Republic of the Philippines
Department of Education
Department of Education Region lV CALABARZON
scHools DlvrsroN oFFIGE oF

IN THE MATTER OF
CORRECTION OF ENTRIES
IN THE SCHOOL RECORDS
OF

Applicant.

APPLICATION
The Applicant, most respectfully submits his/her application and alleges that:

1. The applicant is a learner/completer/graduate of

. He/she finished
e le mentary/seco nd arylgrad e level in
, a schoolsupervised by the
Schools Division Office of
Attached hereto is the Form 137lFS 9/Diploma of the applicant
and is attached as ANNEX "A'n.

2. Upon receipt of hislher Form 137/FS 9/Diploma, the name/birth

date/birth place appeared
as
instead
of
Attached hereto the is
Certificate of Live Birth issued by the Philippine Statistics
Authority and is attached as AHNEX "B".

3. The discrepancy in the entry/entries was because

 . Such fact is
attested by
and who issued an
affidavit which is hereto attached as ANNEX''C".

4. The applicant is presenting the following additional evidence to

prove his/her application:

ANNEX "D'' -
ANNEX "E" -
ANNEX 3'F" -
ANNEX "G"-

WHEREFORE, it most respectfully prayed that after careful review of my

application and its attached evidence, the application be granted.

Other reliefs just and equitable are likewise prayed.

Date Place

Name and signature of applicant

 #
DATA PRIVACY NOTICE AND
CONSENT FORM

ISO 9001 :2015

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DEPED-4A-GFO I 32OO!r*1 S
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VERSION NJO. REWSION NO. EFFECNVIT DAIF
Pcge 1 of I
1.0 0.0 1 SEPTEMBER 2018

DAIA PR,VACY NOIICE AND CONSFNI: Ihe DepFd ry-A CALABAfiZOFJ- LFGAL UNff sholJ cc/Jeci fhe
fallowing dofc:

Order {Conecfion of Fnfi'resJ : Hcrne, birfhdsfe, pkrce of bi#h

i'hese oote shoff be used by DepEd lV-A CATABARZON- TEGAL UNII for lhe purpose of processfng your
requesf for snd shofl be processed by fhe authorized personnel of lhe Legol Unlt fn cccordcnce wiih
the Dcta P.rivccy Policies of ihe Depadmenl of Fducciion and ihe Dcfo Prvccy Acf of !*i? snd its
impiemeniing Rules and Reguloiion.

-Ihereby i cl/ow, authorize cnd conseni DepEd JV-A CATABARZON - LEGAT UNiI to use, colJecl and
process fhese doto forsuch purpose ond allow ris oufhorzed personnelio process the dcfa.

By fixing mysignclure in this forrn. I hereby ofi=st ihai J cgr"ee with the uforententioned condffions.

Nome ond signoture

APPLICATION

Pleqse fill in the following informolion depending on your request:

_Order fConecfion of Enfrfes]

Name of opplfcont

Pioce of tsrrth

Rirlirrin*a

Nome of Schooj
grcduated

Address of Schooj
grcducted

Fntry io be From:
correcied
Io:
 Republic cf the Philippines
Department of Education
RF*ISIf ff-* f,AL"&EAXg*tS
Gate 2 Karangalan Village
1900 Cainta, Rizal

ln re: Conection of School Records

of
x---------- ----------x

TO: Heqd of lhe School

Designotion
Ncme of School
Address

Appliccnt, fited before this Office c request fon correction of (entry) prcying thoi
scid entry in her school records be correcied from _ tc
cs supporfed by her Certificote of Live Birlh issued by ihe Philippine
Stoiistics Auihoriiy" Her letter-request for conection is clso supported by c Joint
Aflicjavit cf Two Disinleresied Persons cs her wifnesses- ollqtiesting to the fcct th.at
ihe irue ond conect nome of the herein opplicont is ond that
the names born on ai and
born on at refer io one
cnd the some person, the herein oppliccnt.

Afier finding the same to hcve complied with all ihe requirements set fcrth by ihis
Office, soid requesi is hereby opproved.

lN VIEW WHEREOf, Heqd of the School, Designolion. Ncrne ol Schoal, Address is

hereby directed thct the necessory conection be duly reflecied in the scholostic
records of the herein oppliccrnt porticulorly in thot school.

SO ORDERED.

This *- doy of 2019, Cointc, Rizcl. Philippines.

Schools Division Superintendenii

Assistont Schools Division Superiniendent

Yrunk Line: {02} 68:-5773,r 684-4914 f r-: Er

iwi
54-?-74&7
Fax {s2} 682-2114
lffebsite: depedcalaba rzon. ph i-7Ql
Faeehook 9epEd R-44 Calabarzon iarai
E-mail: reqion4a@dened.qov.ph
F-mail : legal.calabarzon@deped. gov.ph
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AlA17-0078