Republic of the Philippines

Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR ELEMENTARY TEACHERS

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations and other relative funds assigned to me; and

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at ________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)

CLEARANCE
SCHOOL FORMS FINANCIAL PROPERTY
o MOOE Liquidation/BAC Clearance
o DLLs ________ (if assigned) ________ o Memo. Receipt Clearance ________
o Learner’s Forms ________ o School Revolving Fund ________ o Classroom Furniture ________
o Reports/Records as Subject o Financial Statements ________ o Textbooks/References ________
Chair/Coordinator ________ o Other Assigned Funds ________ o Other Supply Records ________
o Classroom Inventory ________

_____________________________ ___________________________ ________________________________

President, School Teacher’s Club School Treasurer School Property Custodian

_____________________________ ___________________________
School Head District Treasurer ________________________________
District Property Custodian
_____________________________ GLACIE A. BELTRAN
District Supervisor AO IV (Cashier II)
TRINIDAD M. CUSTODIO
ANTONIO U. FELIX MARAH M. PACSON AO IV (Supply Officer II)
Medical Office IV Accountant III

Date: _________________________
TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________ a permanent ______________________ of

(Name) (Position/Designation)
__________________________, _____________________ is cleared of all MONEY, PROPERTY AND SCHOOL FORMS
(School) (District)
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.

ORLANDO C. DE LEON
Administrative Officer V
APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent
 Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR ELEMENTARY SCHOOL HEADS

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations such as MOOE, other local school funds,
municipal Special Education Fund (SEF), Provincial Assistance Fund or other relative funds; and

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at ___________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)
CLEARANCE

SCHOOL FORMS FINANCIAL PROPERTY

o MOOE Liquidation ________
o eSIP ________ o School Revolving Fund ________ o Memo. Receipt Clearance ________
o AIP/APP ________ o Financial Statements ________ o Office Furniture ________
o SBM ________ o Other Local Funds ________ o Other Supply Records ________
o School Forms ________ o BAC Clearance ________ o School Inventory
o OPCRF ________ ________

___________________________
________________________________ School Treasurer ___________________________
President, Teacher’s Club School Property Custodian
___________________________
District Treasurer
________________________________ ___________________________
District Supervisor ___________________________ District Property Custodian
Admin. Assistant In-Charge

________________________________ GLACIE A. BELTRAN

Monitoring Supervisor AO IV (Cashier II) TRINIDAD M. CUSTODIO
AO IV (Supply Officer II)
ANTONIO U. FELIX MARAH M. PACSON
Medical Office IV Accountant III

Date: _________________________
TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________ a permanent ______________________ of

(Name) (Position/Designation)
__________________________, _____________________ is cleared of all MONEY, PROPERTY AND SCHOOL FORMS
(School) (District)
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.
ORLANDO C. DE LEON
Administrative Officer V
APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent
 Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR SECONDARY TEACHERS (NON-FISCALLY AUTONOMOUS SCHOOL)

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations and other relative funds assigned to me;

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at _________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)

CLEARANCE
SCHOOL FORMS FINANCIAL PROPERTY

o DLLs ________ o MOOE Liquidation/BAC Clearance o Memo. Receipt Clearance ________

o Learner’s Forms ________ (if assigned) ________ o Classroom Furniture ________
o Reports/Records as Subject o School Revolving Fund ________ o Textbooks/References ________
Chair/Coordinator ________ o Financial Statements ________ o Other Supply Records ________
o Other Assigned Funds ________ o Classroom Inventory ________

________________________________
Registrar or President, Faculty Club ___________________________ ________________________________
School Treasurer School Property Custodian
________________________________
Department Head (if any)
GLACIE A. BELTRAN
________________________________ AO IV (Cashier II) TRINIDAD M. CUSTODIO
School Head AO IV (Supply Officer II)

ANTONIO U. FELIX MARAH M. PACSON

Medical Office IV Accountant III

Date: _________________________
TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________ a permanent ______________________ of

(Name) (Position/Designation)
__________________________, _____________________ is cleared of all MONEY, PROPERTY AND SCHOOL FORMS
(School) (Municipality)
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.

ORLANDO C. DE LEON
Administrative Officer V
APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent
 Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR SECONDARY SCHOOL HEADS (NON-FISCALLY AUTONOMOUS)

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations such as MOOE, other local school funds,
municipal Special Education Fund (SEF), Provincial Assistance Fund or other relative funds; and

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at ___________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)
CLEARANCE

SCHOOL FORMS FINANCIAL PROPERTY

o MOOE Liquidation ________
o eSIP ________ o School Revolving Fund ________ o Memo. Receipt Clearance ________
o AIP/APP ________ o Financial Statements ________ o Office Furniture ________
o SBM ________ o Other Local Funds ________ o Other Supply Records ________
o School Forms ________ o BAC Clearance ________ o School Inventory
o OPCRF ________ ________

___________________________
________________________________ School Treasurer ___________________________
President, Teacher’s Club School Property Custodian
___________________________
Admin. Assistant In-Charge
________________________________
District Supervisor
GLACIE A. BELTRAN TRINIDAD M. CUSTODIO
AO IV (Cashier II) AO IV (Supply Officer II)
________________________________
Monitoring Supervisor
MARAH M. PACSON
ANTONIO U. FELIX Accountant III
Medical Office IV

Date: _________________________
TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________ a permanent ______________________ of

(Name) (Position/Designation)
__________________________, _____________________ is cleared of all MONEY, PROPERTY AND SCHOOL FORMS
(School) (District)
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.
ORLANDO C. DE LEON
Administrative Officer V
APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent
 Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR SECONDARY SCHOOL HEADS (FISCALLY AUTONOMOUS)

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations such as MOOE, other local school funds,
municipal Special Education Fund (SEF), Provincial Assistance Fund or other relative funds; and

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at ___________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)
CLEARANCE

SCHOOL FORMS FINANCIAL PROPERTY

o MOOE Liquidation ________
o eSIP ________ o School Revolving Fund ________ o Memo. Receipt Clearance ________
o AIP/APP ________ o Financial Statements ________ o Office Furniture ________
o SBM ________ o Other Local Funds ________ o Other Supply Records ________
o School Forms ________ o BAC Clearance ________ o School Inventory
o OPCRF ________ ________
___________________________
School Treasurer
________________________________ ___________________________
President, Teacher’s Club ___________________________ School Property Custodian
Admin. Assistant In-Charge

________________________________ ____________________________
Monitoring Supervisor Accountant
TRINIDAD M. CUSTODIO
AO IV (Supply Officer II)
ANTONIO U. FELIX GLACIE A. BELTRAN
Medical Office IV AO IV (Cashier II)

MARAH M. PACSON
Accountant III

Date: _________________________
TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________ a permanent ______________________ of

(Name) (Position/Designation)
__________________________, _____________________ is cleared of all MONEY, PROPERTY AND SCHOOL FORMS
(School) (District)
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.

ORLANDO C. DE LEON
Administrative Officer V
APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent
 Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR SECONDARY TEACHERS (FISCALLY AUTONOMOUS SCHOOL)

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations and other relative funds assigned to me;

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at _________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)

CLEARANCE
SCHOOL FORMS FINANCIAL PROPERTY
o MOOE Liquidation/BAC Clearance
o DLLs ________ (if assigned) ________ o Memo. Receipt Clearance ________
o Learner’s Forms ________ o School Revolving Fund ________ o Classroom Furniture ________
o Reports/Records as Subject o Financial Statements ________ o Textbooks/References ________
Chair/Coordinator ________ o Other Assigned Funds ________ o Other Supply Records ________
o Classroom Inventory ________
___________________________
________________________________ School Treasurer
Registrar or President, Faculty Club ________________________________
___________________________ School Property Custodian
________________________________ Admin. Assistant In-Charge
Department Head
____________________________
________________________________ Accountant TRINIDAD M. CUSTODIO
School Head AO IV (Supply Officer II)

GLACIE A. BELTRAN
ANTONIO U. FELIX AO IV (Cashier II)
Medical Office IV

MARAH M. PACSON
Accountant III

Date: _________________________
TO WHOM IT MAY CONCERN: GLACIE A. BELTRAN
AO IV (Cashier II)
This is to certify that __________________________________________ a permanent ______________________ of
(Name) (Position/Designation)
MARAH
__________________________, _____________________ is cleared of allM.MONEY,
MANAHAN
PROPERTY AND SCHOOL FORMS
(School) (Municipality) Accountant III
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.
ORLANDO C. DE LEON
Administrative Officer V

APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent
 Republic of the Philippines
Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CLEARANCE FOR SCHOOLS DIVISION OFFICE PERSONNEL

CERTIFICATION
This is to certify that I, _______________________________, of legal age, Filipino, married and a resident of
_________________________________________________________, after having been duly sworn to in accordance with law, hereby
depose and say:
1. That I declare under oath as per verification, that I have no pending administrative, criminal, or civil case in
any Court Office or Agency in the Philippines;

2. That I liquidated and reported all my financial obligations such as MOOE, other local school funds,
municipal Special Education Fund (SEF), Provincial Assistance Fund or other relative funds; and

3. That I am executing this affidavit to effect to the truth of the foregoing instrument.

IN WITNESS WHEREOF, I have hereto set my hand this ______ of ___________________ at _______________.

________________________________
Affiant’s Signature
CTC No. _____________ Issued on________ at ___________

SUBSCRIBED AND SWORN to before me this _____ day of __________________ at ___________________.

MARILOU R. BUENAVENTURA, Ll.B., Ed.D.

PSDS/OIC (Legal Officer)
CLEARANCE

SCHOOL FORMS FINANCIAL PROPERTY

o Required Forms and Reports o Liquidation if assigned ________ o Memo. Receipt Clearance ________
________ o Financial Statements ________ o Office Furniture ________
o Other Local Funds ________ o Other Supply Records ________
o BAC Clearance ________ o Office Inventory ________
ANTONIO U. FELIX, M.D.
President, Non-Teaching Personnel
________________________________
Office Local Treasurer TRINIDAD M. CUSTODIO
________________________________
AO IV (Supply Officer II)
Immediate Section Head
GLACIE A. BELTRAN
ANTONIO U. FELIX
AO IV (Cashier II)
Medical Office IV

________________________________
MARAH M. PACSON
Chief
Accountant III

Date: _________________________
TO WHOM IT MAY CONCERN:

This is to certify that __________________________________________ a permanent ______________________ of

(Name) (Position/Designation)
__________________________, _____________________ is cleared of all MONEY, PROPERTY AND SCHOOL FORMS
(School) (District)
OBLIGATIONS and HAS NO PENDING ADMINISTRATIVE CASE filed in this Office as of this date.

This certification is issued upon the request of the interested party for ______________________________ purpose
effective ____________________.
ORLANDO C. DE LEON
Administrative Officer V

JOHANNA N. GERVACIO, Ph.D. ERICSON S. SABACAN, Ed.D.

OIC-ASDS OIC-ASDS
APPROVED:

RONALDO A. POZON, Ph.D., CESO V

Schools Division Superintendent