Republic of the Philippines

DEPARTMENT OF EDUCATION
Division of Rizal
San Jose – Litex Senior High School
Lot 1 Block 9 Litex Subdivision, San Jose, Rodriguez, Rizal

PERSONAL INFORMATION
LRN: 156505120045
NAME: Capili, Patricia Joy, Solomon
BIRTHDATE: 7/26/2001 AGE: 17
ADDRESS: Blk44Lot21 Jovil 3 brgy San isidro Rodriguez Rizal
RELIGION: Iglesia Ni Cristo CONTACT NUMBER: 09666897157

PARENT / GUARDIAN’S INFORMATION

FATHER’S NAME: Capili Jay,Quimin
OCCUPATION: None CONTACT NUMBER: 09666897157
MOTHER’S MAIDEN NAME: Capili Novie,Solomon
OCCUPATION: OFW CONTACT NUMBER: 09666897157
GUARDIAN’S NAME: Jesus Selagiora,Soqueñe
RELATIONSHIP: Uncle CONTACT NUMBER: 09666897157

EDUCATIONAL DETAILS
STRAND:​ Accountancy, Business and Management (ABM) BALIK ARAL: NO
JUNIOR HIGH SCHOOL: Tagumpay National High School 3RD QUARTER AVERAGE:​ 90
GRADE 10 SECTION: Laboratory GRADE 10 ADVISER: Jofey Manigbas
4P’S RECIPIENT: No INDIGENOUS GROUP: Yes

EARLY REGISTRATION DATE (mm/dd/yyyy): __________________________________

PERSON-IN-CHARGE: ____________________________________________ SIGNATURE: _____________________________________

ENROLMENT PROCEDURE DATE: ​_____________________________________

1. Assessment of Requirements
Requirements:
❏ School Form 9 / Form 138 / Card
❏ School Form 10 / Form 137
❏ NSO / PSA Birth Certificate (Photocopy) Note: ​______________________________________
❏ Good Moral Certificate
❏ Certificate of Completion (Photocopy)
❏ NCAE Result
❏ Voter’s Certification
PERSON-IN-CHARGE: ​______________________________________ SIGNATURE: _____________________________________
Note: After the assessment of your requirements, please secure a copy of your temporary id and attach your 1x1 ID
picture.
2. Approval of Enrolment
SIGNATURE: ______________________________________
Note: After the approval, please photocopy this form (3 pcs) and secure your documents in a long brown envelope.
3. Submission of Requirements
SIGNATURE: ______________________________________