You are on page 1of 2

Republic of the Philippines

Region IV- A CALABARZON


DEPARTMENT OF EDUCATION
DIVISION OF LAGUNA
Santa Cruz
Southville I Elementary School

Date: May 3, 2016

DENTAL CLEARANCE
To: District Supervisor
District of Cabuyao

Sir/Madam:

This is to certify that ROWENA MENANCIO LUSTRE of SOUTHVILLE 1 ES.

Elementary School has complied with the Annual Dental Examination .

Noted:
Should be required and collected by The
District Supervisor on or before May 30, 2016.

---------------------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines


Region IV- A CALABARZON
DEPARTMENT OF EDUCATION
Division of Laguna
DIVISION OF LAGUNA
Santa Cruz
Southville I Elementary School

Date: May 3, 2016

DENTAL CLEARANCE
To: District Supervisor
District of Cabuyao

Sir/Madam:

This is to certify that that ROWENA MENANCIO LUSTRE of SOUTHVILLE 1 ES.

Elementary School has complied with the Dental Examination .

Noted:
Should be required and collected by The
District Supervisor on or before May 30, 2016.
Republic of the Philippines
Region IV- A CALABARZON
DEPARTMENT OF EDUCATION
DIVISION OF LAGUNA
Santa Cruz
Southville I Elementary School

Date:____________

MEDICAL CLEARANCE
To: District Supervisor
District of Cabuyao

Sir/Madam:

This is to certify that ____________________________of_____________________________


Elementary School has complied with the Annual Physical Examination-Tamang Serbisyong Kalusugan
Pampamilya (TSEKAP)

_____________________
Noted: Medical Officer
Should be required and collected by The
District Supervisor on or before May 13, 2016.

---------------------------------------------------------------------------------------------------------------------------------------

Republic of the Philippines


Region IV- A CALABARZON
DEPARTMENT OF EDUCATION
Division of Laguna
DIVISION OF LAGUNA
Santa Cruz
Southville I Elementary School

Date:____________

MEDICAL CLEARANCE
To: District Supervisor
District of Cabuyao

Sir/Madam:

This is to certify that ____________________________of_____________________________


Elementary School has complied with the Annual Physical Examination-Tamang Serbisyong Kalusugan
Pampamilya (TSEKAP)

____________________
Medical Officer

Noted:
Should be required and collected by The
District Supervisor on or before May 13, 2016.

You might also like