Certificate of Honorable Dismissal

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CERTIFICATE OF HONORABLE DISMISSAL

TO WHOM IT MAY CONCERN:

This is to certify that ___________________________, Grade VI-Colossians is granted


HONORABLE DISMISSAL from this school effective today, _______________. His
Transcript of Record will be released upon request of the enrolling school.

DINA C. BACANI
School Registrar

(This portion is to be filled in by the enrolling school and sent back to SAN BARTOLOME
ELEMENTARY SCHOOL, Concepcion South District, San Bartolome Concepcion, Tarlac. No
other request form will be honored).

THE REGISTRAR
San Bartolome Elementary School
Concepcion South District
San Bartolome Concepcion, Tarlac

Madam:

Mr/Ms. ___________________________________ has been temporarily enrolled in the


______________________________________ upon presentation of his/her Certificate of
Honorable Dismissal dated ______________________________.

_________________________
Registrar

School: ______________________________
Address: _____________________________

Student’s Signature ______________________________

Clearance
Transcript
Yr & Sec.
Sem/SY Attended:

This request is not valid unless it bears the signature of the pupil.
Concepcion South District
SAN BARTOLOME ELEMENTARY SCHOOL
Concepcion, Tarlac

CERTIFICATE OF HONORABLE DISMISSAL

TO WHOM IT MAY CONCERN:

This is to certify that IAN KARL V. SANTOS, Grade VI-Colossians is granted

HONORABLE DISMISSAL from this school effective March 18, 2019. His Transcript of

Record will be released upon request of the enrolling school.

ROSALIE J. SANTIANO
Head Teacher III
School Registrar

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