2010-ESCF01-01

ESC Form 1-Billing Statement (ESC-Returnees)

For All Regions Except NCR

This Billing Statement also serves as the contract between DepED and the private school with regard to the latter's
participation in the ESC program of the GASTPE in accordance with the program guidelines issued for the school
year stated above.

Instructions: Please prepare 4 copies of this form and no erasures.

Billed to: Department of Education Date:

Address: Pasig City

School Id:
School Name:
School Address:
On account of: ESC Grants for School Year 2011-2012

Total Grantees & Amount Due for ESC School Year 2011-2012(ESC-Returnees)

Year Level No. of Amount of Grant Total Amount Due by Year

Grantees Level
First Year 5,500.00
Second Year 5,500.00
Third Year 5,500.00
Fourth Year 5,500.00
Total Grantees Total Amount Due

We certify, under the penalties of perjury, that the data entered above are consistent with the list of qualified ESC-Returnees listed in
ESC Form 2.

Parents' Association President/Representative Faculty Association President/Representative

School Head

Note: Signature over printed name.

Special Instructions:

Please deposit payments to school's account with Land Bank of the Philippines (LBP). The account details of which are as follows:

Branch:

School Account Name:

Account number:

Requirement: Please attach an IMI1 or STI1 printout from signed by the bank's branch manager.

Recommending approval for payment amounting to Php_______________________________

Ms. Carolina C. Porio

FAPE Executive Director
 ESC Form 2-List of Grantees for SY 2011-2012(ESC-Returnees)
School ID Name of School 2010-ESCF02-01
Page of
Region Province Municipality Street/Barangay No. of grantees for this page

Instructions: Please prepare 4 copies. Type the data needed. The students' names shall be alphabetically arranged (Last Name first and then First Name) regardless of gender, year level, or class section. No erasures allowed.
No. Last Name First Name MI Gender Current Year Level Last School Year Attended Reason for Dropping/Leaving School No.

We certify, under the penalties of perjury, that the list of students entered above are the qualified ESC-Returneesfor School Year 2011-2012in accordance with the ESC Implementing Guidelines and have attended classes until July
15, 2010.

Parents' Association President/Representative Faculty Association President/Representative School Head

Note: Signature over printed name.

 2010-ESCF03-01

ESC Form 3-Certification of Tuition and Other School Fees

For School Year 2018-2019
School Id: 1101524
School Name: HOLY CROSS OF BABAK, INC.
School Address: VILLARICA, BABAK, ISLAND GARDEN CITY OF SAMAL

Grade 7 Grade 8 Grade 9 Grade 10

I. Tuition Fee 10,600.00 10,600.00 10,600.00 10,600.00

II. Other School Fees

(Please indicate breakdown)
REGISTRATION 115.00 115.00 115.00 115.00
LIBRARY 115.00 115.00 115.00 115.00
LABORATORY 115.00 115.00 115.00 115.00
ATHLETIC 115.00 115.00 115.00 115.00
MEDICAL/DENTAL 115.00 115.00 115.00 115.00
GUIDANCE & COUNSELING 115.00 115.00 115.00 115.00
SCHOOL PUBLICATION 115.00 115.00 115.00 115.00
TEST PAPER 500.00 500.00 500.00 500.00
SECURITY GUARD 505.00 505.00 505.00 505.00
AUDIO VISUAL 163.00 163.00 163.00 163.00
STUDENT ACTIVITY 163.00 163.00 163.00 163.00
SPEECH LABORATORY 155.00 155.00 155.00 155.00
DEVELOPMENT FEE 200.00 200.00 200.00 200.00
Total Other Standard School Fees 2,491.00 2,491.00 2,491.00 2,491.00

III. Miscellaneous Fees

(Please indicate breakdown)

Total Other Non-standard School Fees P P P P

IV. Total School Fees (Sum of Part I, Part II, and Part III)
13,091.00 13,091.00 13,091.00 13,091.00
V. Please indicate any special concessions given to ESC grantees (e.g. tuition waiver, discounts, any forms of assistance, etc.)
P P P P

We certify, under the penalties of perjury, that the above information contained herein is true and correct and is in accordance with the
ESC Implementing Guidelines.

MS. JOSIE MAE NAIDAS MAGONCIA MR. JANUS DAHILOG RAFAILES

Faculty Association President/Representative Parents' Association President/Representative

SR. MA. FLORENDA CALUPISAN MISIONA, TDM

School Head
Note: Signature over printed name.