Jo Malem

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Republic of the Philippines

Department of Education
Davao Oriental
BAGANGA NATIONAL HIGH SCHOOL
Quezon St., Poblacion, Baganga, Davao Oriental

STUDENT INFORMATION
LRN 465519150027
Complete Name JOMALEM ADAO MATILAC
Mailing Address MAHAN-UB, Baganga, BAGANGA DAVAO ORIENTAL

Birth Date 15-Sep-2008 Age Blood14


Type
Birth Place MAHAN-UB, BAGANGA DAVAO ORIENTAL
Sex Female Civil Single Citizenship Filipino
Status
Contact Details ( ) -
Landline No. Mobile No. E-mail Address

Religion: Roman Catholic Ethnicity Mandaya


Last School BAGANGA NATIONAL HIGH SCHOOL
Attended
Address Quezon St., Poblacion, Baganga, Davao Oriental

PARENTS/GUARDIAN
INFORMATION
Father's Name RUBEN JAPITAN MATILAC Occupation: FARMER
Monther's Name LOIDA MATICADING ADAO Occupation: FARMER

Guardian: LOIDA MATUCADING ADAO Relationshi Mother


p:
Address: MAHAN-UB, BAGANGA Contact
DAVAO ORIENTAL No.:

Deparment Junior High School Grade Grade 7 Section Humility


Level
Specialization Academic -
Adviser MARY GRACE AMPILANON SALIENTES
4 P's Beneficiary? Yes IP Member? No Balik Aral? No Repeater No

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.

LOIDA MATUCADING ADAO June 21, 2023


Signature Over Printed Name of Parent/Guardian Date

Address: Quezon St., Poblacion, Baganga, Davao Oriental


Telephone No.: (087) 201-1493

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