Registrar Form 1-6,17

CAV FORM 1- REQUEST FORM – SCHOOL (RF)
Republic of the Philippines

Department of Education
Region VII, Cebu City
Division of Danao City
Control No.: _________________

Date of Application: ___________
Date of Release: ______________
School Name: BEATRIZ D. DURANO MEMORIAL NATIONAL HIGH SCHOOL
School ID: 302957
REQUEST FORM FOR ACADEMIC SCHOOL RECORDS
JUAN DE LA CRUZ
NAME OF LEARNER: ____________________________________________________________________
JANUARY 01, 2017
DATE & PLACE OF BIRTH: ________________________________________________________________
2017-2018
SCHOOL YEAR LAST ATTENDED / GRADUATED: _______________________________________________
C.M ENRIQUEZ ST. SUBA, DANAO CITY
PRESENT ADDRESS: _____________________________________________________________________
_____________________________________________________________________
09123456789
CONTACT NO. : ________________________________________________________________________
PURPOSE: (Please check any of the following):
√ EMPLOYMENT ABROAD √ FIANCE VISA √ STUDENT VISA
√ SEAMAN’S BOOK/SRC √ TOURIST VISA √ DESCENDANT’S VISA
√ MIGRATION ABROAD √ REIMBURSEMENT OF EDUCATIONAL

ALLOWANCE/TUITION FEES OF CHILDREN OF OFWs.
√ SUCH OTHER PURPOSE AS MAYBE REQUIRED BY THE DFA
JUAN DE LA CRUZ
_________________________
Signature Over Printed Name
(Applicant / Representative)
CAV FORM 2 – SCHOOL REFRERRAL TO DIVISION OFFICE

BEATRIZ D. DURANO MEMORIAL NATIONAL HIGH SCHOOL
1st Indorsement
Date
Respectfully forwarded to the Schools Division Superintendent, Division of

DANAO CITY, requesting for assistance in securing a certified true copy of School Form 18 (now
School Form 5) for reconstruction of Form 137 in relation to the herein attached request
JUAN DE LA CRUZ
of____________________________________, who claims to be a graduate of / student in
BEATRIZ D. DURANO MEMORIAL NATIONAL HIGH SCHOOL during the School Year __________.
2017-2018
The said record, despite diligent search, is not available in this office.
For the preferential appropriate action of the Schools Division Superintendent.
RAMIL G. LAVADOR
Principal I
Attached: as stated.
CAV FORM 3 – INDORSEMENT FOR CORRECTION OF ENTRIES IN THE ACADEMIC SCHOOL RECORDS

1st Indorsement
Date
VII
Respectfully forwarded to the Regional Director, DepEd Regional Office ________,
SUDLON, LAHUG, CEBU CITY (Attention: Attorney IV, Legal Unit) requesting for assistance in
_________________________,
JUAN DE LA CRUZ
the Correction of Entries in the Academic School Records of ___________________________, as
a graduate of / student in ___________________________________________________ during
2017-2018
the School Year _______________.
For ready reference and perusal, attached are the following documents / records:
1. Certificate of Live Birth (issued by Philippine Statistics Authority);

2. Affidavit of Discrepancy;
3. Affidavit if two (2) Disinterested Persons;
4. Form-137
5. Diploma
For the preferential appropriate action of the Regional Director.
RAMIL G. LAVADOR
Principal I
CAV FORM 4 – CERTIFICATION OF ENROLMENT / COMPLETION / GRADUATION

REQUEST FORM FOR ACADEMIC SCHOOL RECORDS
TO WHOM IT MAY CONCERN:
This is to certify that, based on available records in this school, the following information
JUAN DE LA CRUZ
pertaining to _________________________________with Learner Reference Number
302957123456
__________________appear.
( √ ) enrolled in Grade ______ during the School Year ________

2017-218
( √ ) completed Grade ______ during the School Year ________

2017-218
( √ ) satisfactory graduated from Elementary / Secondary Course for the School Year
2017-218 as prescribed by the Department of Education.

__________
DECEMBER 12, 2017 upon the request of the Name of

This certification is issued on _________________
Learner in connection with his/her application for Certification, Authentication and Verification.
RAMIL G. LAVADOR
Principal I
“If graduated from secondary course in private school, indicate Special Order Number and date.”
CAV FORM 5 – SCHOOL TRANSMITTAL TO THE REGIONAL OFFICE

1st Indorsement
Date
VII
Respectfully forwarded to the Regional Director, DepEd Regional Office ________,
SUDLON, LAHUG, CEBU CITY the herein request of __________________________________
_________________________, JUAN DE LA CRUZ
for Certification, Authentication and Verification (CAV) of his / her Academic School Records.
For ready reference and perusal, attached are the following documents / records
marked ( √ ) below enclosed in sealed envelope:
( √ ) Certification of Completion/Graduation
( √ ) Certification of English as Medium of Instruction
( √ ) Form-137
( √ ) Diploma
For the preferential appropriate action of the Regional Director.
RAMIL G. LAVADOR
Principal I
CAV FORM 6 – LIST OF APPROVED CAV REQUEST

DATE OF
CONTROL NO. NAME DATE OF APPLICATION
TRANSMITTAL
001 JUAN DE LA CRUZ DECEMBER 12, 2017 DECEMBER 12,2017
Prepared by:
ARNULFO T. TOMINES
School Registrar
Submitted by:
RAMIL G. LAVADOR
Principal I
CAV FORM 17 – CERTIFICATION OF ENGLISH AS A MEDIUM OF INSTRUCTION

C E R T I FI C A T I O N
TO WHOM IT MAY CONCERN:
JUAN DE LA CRUZ
This is to certify that ___________________________________ with Learner Reference Number
302957123456 has satisfactory completed / graduated from the Elementary / Secondary Course as
_________________
prescribed by the Department of Education, with the following particulars:

1. Name of School : _____________________________________________________________
P.G ALMENDRAS ST. SUBA, DANAO CITY
2. School Address : ______________________________________________________________
GRADE 10
3. Grade level completed : ______________________ 2017-2018
School Year completed : _____________
APRIL 01, 2018
4. Graduated on : ______________________ 2017-2018
School Year graduated : _____________________
5. Special Order Number : ____________________________ Date : _______________________
This is to further certify that English Language was used as the medium of instruction in
all Subjects taught in the above-mentioned school, except for subjects that require the use of Filipino
language only.
DECEMBER 12, 2017 upon the request of

This certification is issued on ____________________
JUAN DE LA CRUZ
_____________________________ in connection with his / her application for Certification,
Authentication and Verification.
RAMIL G. LAVADOR
Principal I
“If graduated from secondary course in private school, indicate Special Order Number and date.”

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CAV FORM 1- REQUEST FORM – SCHOOL (RF)

Republic of the Philippines

Control No.: _________________

School Name: BEATRIZ D. DURANO MEMORIAL NATIONAL HIGH SCHOOL

School ID: 302957

REQUEST FORM FOR ACADEMIC SCHOOL RECORDS

PURPOSE: (Please check any of the following):

√ EMPLOYMENT ABROAD √ FIANCE VISA √ STUDENT VISA

√ SEAMAN’S BOOK/SRC √ TOURIST VISA √ DESCENDANT’S VISA

√ MIGRATION ABROAD √ REIMBURSEMENT OF EDUCATIONAL

√ SUCH OTHER PURPOSE AS MAYBE REQUIRED BY THE DFA

Republic of the Philippines

Respectfully forwarded to the Schools Division Superintendent, Division of

For the preferential appropriate action of the Schools Division Superintendent.

Republic of the Philippines

1. Certificate of Live Birth (issued by Philippine Statistics Authority);

For the preferential appropriate action of the Regional Director.

Republic of the Philippines

REQUEST FORM FOR ACADEMIC SCHOOL RECORDS

TO WHOM IT MAY CONCERN:

( √ ) enrolled in Grade ______ during the School Year ________

( √ ) completed Grade ______ during the School Year ________

2017-218 as prescribed by the Department of Education.

DECEMBER 12, 2017 upon the request of the Name of

Republic of the Philippines

( √ ) Certification of English as Medium of Instruction

For the preferential appropriate action of the Regional Director.

Republic of the Philippines

Republic of the Philippines

TO WHOM IT MAY CONCERN:

BEATRIZ D. DURANO MEMORIAL NATIONAL HIGH SCHOOL

DECEMBER 12, 2017 upon the request of

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( √ ) enrolled in Grade during the School Year __

( √ ) completed Grade during the School Year __