What I Know

Directions: Fill out the form below. Complete it by using the possible answers
found inside the box. Use the form provided to you.

Student Personal Information

Name: ____________________________________________________________

Grade & Section: ___________________Age: _____ Sex: _______________

Teacher: __________________________________________________________

Address: __________________________________________________________

Birthday: __________________________ Country: _____________________

School: ___________________________________________________________

Royce L. Cabrera Male Ms. Rina B. Macaraig

Grade V- Maagap December 25, 2010

Catbalogan City, Samar San Roque Elementary School

Philippines 10

2 CO_Q1_English5_Module1
 What’s In

Directions: Examine the forms below and then identify each. Pick your answer
from the choices inside the box. Write it on your answer sheet.

cash deposit slip school form

withdrawal slip

1. 2.

3.

3 CO_Q1_English5_Module1
 What’s New

Thinking Beyond

Directions: Examine closely the completed (filled out) forms and the required
information that was supplied in each form. Using a Venn diagram, write down the
similarities and differences of the forms based on the required information in filling
it out. Do this on your answer sheet.

CASH DEPOSIT WITHDRAWAL

SLIP Write here the SLIP
required
Write here the information Write here the
required found on both required
information found the cash deposit information found
on the cash and withdrawal on the withdrawal
deposit slip. slips. slip.

4 CO_Q1_English5_Module1
 What Is It

A deposit slip is a small paper form that a person includes with a bank
deposit to show how much money he or she is putting in a bank account. It contains
the deposit date, name and bank account number of the depositor, and the amount
to be deposited in the form of checks or cash, and the signature of the depositor.

Specifically, a person who deposits or places money in a bank account is called

a depositor.

How to Fill out a Deposit Slip

1. First, write your name and bank account number.

2. Then, supply additional details, such as transaction date and any branch
information required.
3. List the cash amount breakdown of your deposit and the total amount
thereafter.
4. Affix your signature over printed name found on the lower part of the form.

5 CO_Q1_English5_Module1
 On the other hand, a withdrawal slip is a small paper form which has to be
filled out before making a withdrawal of money from a bank. After filling out the bank
slip, a person signs on it in the presence of a bank teller. A bank teller is an employee
of the bank whose job is to help bank customers with their banking needs, such as
depositing checks or cash or making a withdrawal.

How to Fill out a Withdrawal Slip

1. First, write your name and the date.

2. Then, write the desired amount of your withdrawal in words and in figures.
3. Finally, affix your signature on the signature line found on the form, but do
this only until a bank teller can witness you signing it.

This time let us try to go through a very common form that you usually
accomplish every school year. Are you familiar with this form?

6 CO_Q1_English5_Module1
 ANNEX 1

MODIFIED BASIC EDUCATION ENROLLMENT FORM

THIS FORM IS NOT FOR SALE.

Check the appropriate box only:

School Year: - No LRN With LRN

Grade level to Enroll: Returning (Balik-Aral)

INSTRUCTIONS: Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.

STUDENT INFORMATION
PSA Birth Certificate No. (if available upon registration)

Learner Reference No. (LRN)

LAST NAME

FIRST NAME

MIDDLE NAME

EXTENSION NAME e.g. Jr., III (if applicable)

DATE OF BIRTH / / SEX MALE FEMALE AGE

(Month/Day/Year)

Belonging to any Indigenous Peoples (IP)

Community/Indigenous Cultural Community? No Yes If Yes, please specify:

Mother Tongue
ADDRESS
House Number and Street

Barangay

City/Municipality/Province/Country
Zip Code

PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name) Mother’s Maiden Name (Last Name, First Name, Middle Name)

Guardian’s Name (Last Name, First Name, Middle Name)

Telephone No. Cellphone No.

For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In

Last Grade Level Completed Last School Year Completed

School Name School ID

School Address

For Learners in Senior High School

7 CO_Q1_English5_Module1
Semester 1st Sem 2nd Sem
Track Strand (if any)

Preferred Distance Learning Modality/ies

Modular (Print) Online Radio-based instruction Blended

Modular (Digital) Educational TV Homeschooling

I hereby certify that the above information given are true and correct to the best of my
knowledge and I allow the Department of Education to use my child’s details to create and/or update
his/her learner profile in the Learner Information System. The information herein shall be treated as
confidential in compliance with the Data Privacy Act of 2012.

Signature Over Printed Name of Parent/Guardian Date

Notice that this form uses boxes to be accomplished with specific instructions.
Let’s do this!
The first field asks for the school year. There are 8 boxes separated with a
dash (-) in between four boxes. This means you are to put the numerical
representation of the school year you are enrolling in.
Ex. 2020-2021

On the upper right corner of this form, you will notice the instruction “Check the
appropriate box only:”
Here you will put a check mark only on the field that is true to your situation.

Ex. (check on the with LRN)

Pay attention to the main instruction reflected on this form. There are fields that
require you to write in capital letters. For example:

LAST NAME (please play out the boxes) DE LA CRUZ

FIRST NAME JUAN

MIDDLE NAME GARCIA

EXTENSION NAME JR.

Further, under the date of birth, boxes where you can place your birth details
appear. Sometimes, these bits of information use a pattern like this:

MM-DD-YYYY

This means, you are going to put the numerical representation of the month of
birth. For example, January will be reflected as 01, the day of your birth falling on

8 CO_Q1_English5_Module1
 the 28th of January will show 28; and lastly, the year of your birth is written in full
as 1978. Therefore, you will accomplish this field following this example:
Example:

DATE OF BIRTH 0 1 / 2 8 / 1 9 7 8
(Month/Day/Year)

Let us give emphasis on ticking boxes appropriately, writing CAPITAL

LETTERS when required, placing name extensions, and representing information in
numerical form.

Example:

ANNEX 1
MODIFIED BASIC EDUCATION ENROLLMENT FORM
THIS FORM IS NOT FOR SALE.

Check the appropriate box only:

School Year: 2 0 2 0 - 2 0 2 1 No LRN / With LRN

Grade level to Enroll: V Returning (Balik-Aral)

INSTRUCTIONS: Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.

STUDENT INFORMATION
PSA Birth Certificate No. (if available upon registration)

Learner Reference No. (LRN) 5 0 1 9 1 8 1 2 3 4

LAST NAME D E L A C R U Z

FIRST NAME J U A N

MIDDLE NAME G A R C I A

EXTENSION NAME e.g. Jr., III (if applicable)

DATE OF BIRTH 0 1 / 2 8 / 1 9 7 8 SEX / MALE FEMALE AGE 43

(Month/Day/Year)

Belonging to any Indigenous Peoples (IP) /

Community/Indigenous Cultural Community?
No Yes If Yes, please specify:

Mother Tongue Waray

ADDRESS
House Number and Street

Real Street
Barangay

Poblacion 01
City/Municipality/Province/Country
Zip Code 6 7 2 2
Daram, Samar
PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name) Mother’s Maiden Name (Last Name, First Name, Middle Name)
DELA CRUZ, RICARDO MENDOZA
GARCIA, JOSEFA SILANG

9 CO_Q1_English5_Module1
 DELA CRUZ, RICARDO MENDOZA
Guardian’s Name (Last Name, First Name, Middle Name)

Telephone No. Cellphone No. 09105954692

For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In

Last Grade Level Completed Last School Year Completed

School Name School ID

School Address

For Learners in Senior High School

Semester 1st Sem 2nd Sem
Track Strand (if any)

Preferred Distance Learning Modality/ies

/ Modular (Print) Online Radio-based instruction Blended

Modular (Digital) Educational TV Homeschooling

I hereby certify that the above information given are true and correct to the best of my
knowledge and I allow the Department of Education to use my child’s details to create and/or update
his/her learner profile in the Learner Information System. The information herein shall be treated as
confidential in compliance with the Data Privacy Act of 2012.

RICARDO M. DELA CRUZ 07-10-2021

Signature Over Printed Name of Parent/Guardian Date

10 CO_Q1_English5_Module1
 What’s More

Directions: Fill out a withdrawal slip using the suggested information found in the
box. Use the form provided to you.

• July 1, 2020
• 1234567891
• Criselda V. Castillo
• Ten Thousand
Pesos
• P 10,000.00

11 CO_Q1_English5_Module1
 What I Have Learned

To fill out a form is to complete a form by writing the required information

on it.

There are two forms that bank customers use to address their banking needs.
One is a deposit slip which is a small paper form that a bank customer includes
with a bank deposit to show how much money he or she is putting in a bank account.
Another is a withdrawal slip which is a small paper form that has to be filled out
before making a withdrawal of money from a bank.

Moreover, a depositor is a person who deposits or places money in a bank

account, whereas a bank teller is an employee of the bank whose job is to help bank
customers with their banking needs, such as depositing checks or cash or making a
withdrawal.

Additionally, a school enrolment form is a school document that shows

information about a learner or student who enrolls in a specific school. This form
also contains the learner’s profile that includes details on where he or she lives and
the learner’s current school records such as class and grade level to cite some
examples.

As a whole, there are particular forms that you have to fill out as a
requirement for admission to a school or when transacting in a bank. Accuracy is
very important in filling out these forms.

12 CO_Q1_English5_Module1
 What I Can Do

Helping a Friend

Directions: Read the selection about Ana and her Grandma. Help your friend, Ana,
by completing the withdrawal slip for her grandma. Use the form provided to you.

Off to the Bank

Hi, my name is Ana. I will accompany my Grandma to the

bank today. Grandma told me that we have to drop by the bank
before going to the mall to buy me a birthday present. Today is
May 28, 2020 and two days from now I will be turning 10!
Grandma needs money for the birthday present. Today,
she will get 3,000 pesos from her bank account. She will have to
complete a form and she calls it a withdrawal slip. Can you help
Grandma complete the form, so that we can have the money for
my birthday present? Yehey! Thank you.

Don’t forget to leave the depositor’s signature line empty,

so that Grandma can sign it.

Here’s Grandma’s bank information.

Name : Linda Cruz

Account Number : 0977 4444 88

13 CO_Q1_English5_Module1
14 CO_Q1_English5_Module1
 Assessment

Directions: You have a savings bank account and you want to put an amount of
2, 000 pesos into it, with the following cash breakdown: two five hundred-peso bills
and ten one hundred-peso bills. Using the bank account number 0344- 5555- 22,
complete a cash deposit slip. Fill out the form provided to you.

15 CO_Q1_English5_Module1
 Additional Activities

Directions: Complete the school form shown below. Use the form provided to you.

ANNEX 1

MODIFIED BASIC EDUCATION ENROLLMENT FORM

THIS FORM IS NOT FOR SALE.

Check the appropriate box only:

School Year: - No LRN With LRN

Grade level to Enroll: Returning (Balik-Aral)

INSTRUCTIONS: Print legibly all information required in CAPITAL letters. Submit accomplished form to the
Person-in-Charge/Registrar/Class Adviser. Use black or blue pen only.

STUDENT INFORMATION
PSA Birth Certificate No. (if available upon registration)

Learner Reference No. (LRN)

LAST NAME

FIRST NAME

MIDDLE NAME

EXTENSION NAME e.g. Jr., III (if applicable)

DATE OF BIRTH / / SEX MALE FEMALE AGE

(Month/Day/Year)

Belonging to any Indigenous Peoples (IP)

Community/Indigenous Cultural Community?
No Yes If Yes, please specify:

Mother Tongue
ADDRESS
House Number and Street

Barangay

City/Municipality/Province/Country
Zip Code

PARENT’S/GUARDIAN’S INFORMATION
Father’s Name (Last Name, First Name, Middle Name) Mother’s Maiden Name (Last Name, First Name, Middle Name)

Guardian’s Name (Last Name, First Name, Middle Name)

16 CO_Q1_English5_Module1
Telephone No. Cellphone No.

For Returning Learners (Balik-Aral) and Those Who Shall Transfer/Move In

Last Grade Level Completed Last School Year Completed

School Name School ID

School Address

For Learners in Senior High School

Semester 1st Sem 2nd Sem
Track Strand (if any)

Preferred Distance Learning Modality/ies

Modular (Print) Online Radio-based instruction Blended

Modular (Digital) Educational TV Homeschooling

I hereby certify that the above information given are true and correct to the best of my
knowledge and I allow the Department of Education to use my child’s details to create and/or update
his/her learner profile in the Learner Information System. The information herein shall be treated as
confidential in compliance with the Data Privacy Act of 2012.

Signature Over Printed Name of Parent/Guardian Date

17 CO_Q1_English5_Module1