Republic of the Philippines

Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: February 8, 2019

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:_MULTIPLE LRN
LEARNER’S DETAILS
LRN (if applicable) : 121614140007
NAME: MENDOZA INIEGO CABAHUG
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: JUNEY 27, 2005
GARDE LEVEL: GRADE SIX

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
1. Birth Certificate
2. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
1. Birth Certificate
Request to Unenroll and Other Issues
1. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : 13846150018
NAME: MIRAMBEL, CRIS FUERTES
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: MAY 14, 2010
GARDE LEVEL: GRADE TW0

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
1. Birth Certificate
2. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
1. Birth Certificate
Request to Unenroll and Other Issues
1. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : 107471160104
NAME: MIRAFLOR PRINCE WILLIAM MAHABA
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: AUGUST 29, 2011
GARDE LEVEL: GRADE ONE

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
1. Birth Certificate
2. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
1. Birth Certificate
Request to Unenroll and Other Issues
1. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : 107473160058
NAME: ESPINAS RALPH DAVID BONZO
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: MARCH 10, 2011
GARDE LEVEL: GRADE ONE

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
3. Birth Certificate
4. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
2. Birth Certificate
Request to Unenroll and Other Issues
2. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : 107473160070
NAME: ESPINAS KIM AUDREY BONZO
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: June 15, 2009
GARDE LEVEL: GRADE ONE

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
1. Birth Certificate
2. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
2. Birth Certificate
Request to Unenroll and Other Issues
2. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : 107710160004
NAME: DELOS REYES, RAYVEN VILLANUEVA
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: NOVEMBER 13, 2010
GARDE LEVEL: GRADE ONE

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
5. Birth Certificate
6. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
3. Birth Certificate
Request to Unenroll and Other Issues
3. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : 107471160017
NAME: MANCIO JOHANA MARIE S
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: AUGUST 12, 2011
GARDE LEVEL: GRADE ONE

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
3. Birth Certificate
4. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
3. Birth Certificate
Request to Unenroll and Other Issues
3. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org

 Republic of the Philippines
Department of Education
Region IV-A CALABARZON
DIVISION OF BATANGAS
Batangas Provincial Sports Complex, Bolbok, Batangas City

PLANNING AND RESEARCH SECTION

REQUEST FORM
Learners Information System (LIS) Data Issues
***To be filled up by the requesting school.

DATE: September 10, 2018

SCHOOL ID: 107471
NAME OF SCHOOL: MALVAR CENTRAL SCHOOL
NAME: GILBERTO L. PEREZ SIGNATURE: ______________________
CONTACT NUMBER: 09399128939 E-MAIL ADD: malvarcentral_school@yahoo.com/malvarcs107471@gmail.com
TYPE OF REQUEST: LRN APPROVAL
ENROLMENT OF INELIGIBLE
ENROLMENT WITH GAP
CORRECTION OF BASIC PROFILE (ALS)
REQUEST TO UNENROLL
OTHERS:____________________
LEARNER’S DETAILS
LRN (if applicable) : _______________________
NAME: CAPILI FRENZ NHIGEL NGANNOY
( Last Name) ( First Name) ( Middle Name)
DATE OF BIRTH: JUNE 13, 2011
GARDE LEVEL: GRADE TW0

***Required Documents
LRN Approval/Enrolment of Ineligible/with GAP
7. Birth Certificate
8. ECCD Checklist/Form 137/Form 138/SF5/Certification
Correction of Basic Profile (ALS)
4. Birth Certificate
Request to Unenroll and Other Issues
4. Request Letter and other relevant documents

***To be filled up by the Planning and Research personnel.

Received by: ________________________________________ Date: __________________

Documents Submitted: Complete With System Request: YES
Incomplete NO
Status of Request: For Approval
For Disapproval
Pending
No Action

REMARKS: ____________________________________

Evaluated by: __________________________________

Approved by: __________________________________

DEPEDBATS-PAR-F-023/R1/07-25-2018

(043) 722-1840 / 722-1796 / 722-2675 /722-1662 / (043) 723-2816 deped.batangas@deped.gov.ph depedbatangas.org