5

ENGLISH
Quarter 1- Module 1:
Filling Out Forms

Department of Education - MIMAROPA Region

 Development Team of the Module
Author: Josephine Lerio Malaluan
Editors: Adelardo I. Malaluan,PhD, Hazel Portia C. Austria
Reviewers: Julie Ann Cueto, Adrian Anthony D. Osano
Illustrators: Alexander P. Abeleda, Edhen P. Martin, Louie J. Cortez, Jefferson Repizo
Layout Artist: Mark Roger A. Dacayanan
Management Team:
BENJAMIN D. PARAGAS, CESO V ATTY. SUZETTE T. GANNABAN -MEDINA
Director IV Chief Administrative Officer
Regional Director OIC, Office of the Assistant Regional Director

MARIFLOR B. MUSA ROGER F. CAPA,CESO VI ARNALDO G. VENTURA, PhD RAQUEL P.GIRAO, PhD
Chief CLMD SDS ASDS CID Chief

FREDDIE REY RAMIREZ EDNA C. OABEL ADELARDO I. MALALUAN, PhD ELIZABETH T. DELAS ALAS, PhD
LRMDS Supervisor EPS - English Division EPS LRMDS Supervisor

What I Need To Know

After going through this module, you are expected to:

 fill out forms accurately such as information sheet, deposit and

withdrawal slips; and

 apply the skills in real life situation in depositing and withdrawing

money from the bank and fill out information sheet.

2
 What I Know
You have learned in your past lesson how important it is to
follow directions. Do the following instructions in your notebook and prove
that you can understand and follow the directions very well.

1. Read everything before you start.

2. Write your name at the middle of your paper.

3. Encircle your name.

4. Draw small triangle at the top of the circle.

5. At the bottom of the page, write your school name and underline it.

6. Write your favorite color at the top of your paper.

7. Now, that you have finished reading the directions carefully, do

number 1 direction only.

Lesson
1
Filling Out Forms

Since you are now a Grade 5 student, you must know how to fill out

the forms like enrollment or information form as well as deposit and

withdrawal slips. It is a good idea to read the entire form before you start to

fill it out. If you look over the whole form first, you will be able to put the

required information in the correct place. In order to avoid mistakes, you

should make a draft first of your answers before you write them into the form.

3
 What’s In

Read the selection about Bella and her grandmother.

Study the filled out withdrawal slip that Bella completed below.

Off to the Bank

Hi! my name is Bella. I will accompany my Grandmother to

the bank today. Grandma told me that we have to drop to the bank

before going at mall to buy a birthday present for my brother.

Today is May 28, 2020 and two days from now he will be turning 19.

Grandma needs money for his birthday present. So, she asked me to

withdraw 3,000 pesos from her bank account. I have to fill out a withdrawal

slip form. Then, Grandma gives me her bank information and instructed to

leave the depositor’s signature line empty, so that she can sign on it.

Here is Grandma’s bank information

Name: Linda Cruz

Account Number: 097 7 44678901-3

Observe the filled out withdrawal form.

4
Comprehension Check!

Directions: Answer the following questions in your notebook.

1. Who assisted her grandmother to the bank?

2. When is Bella’s brother birthday?
3. How much money did Bella need to withdraw from the bank?
4. What is their purpose in withdrawing the money?
5. What is the form needed to be filled out ?

What’s New

Here is the customer information sheet needed to fill out before

entering the bank for contract tracing purposes. Try filling it out with your

own personal data. Be sure to follow the printed directions in the form.

Customer Information Sheet

Introdu
Temperature
(Please write in bold letters) ctory
Messag
______________ ________________ ________ e
SURNAME GIVEN NAME M.I.
For the
Birth Date: Age: facilitat
or:
Contact Number: E- mail address:
Date of Visit: Time of Visit: This
Self-
Purpose/ Transaction:
Learnin
Signature: g
Module
(SLM)
focuses
5 on
inferrin
g the
 Now here is a sample deposit slip. Adriel Ace P. Malaluan, Bella’s friend,

filled it out. He would like to deposit the money he received from his

grandparents last Christmas which amounted to 1, 785.00 pesos.

Study the deposit slip below.

Who is the depositor?

What is the account number?
How many P1,000 bill does he have?
How much is the total deposit?

Adriel Ace P. Malaluan is the depositor. His account is

2465212626918. He has P1,000 bill, one P500 bill, one P100 bill, three

P50 bill, one 20 bill, one P10 bill, and one 5 coin. His total deposit for the

transaction amounted to P1, 785.00.

6
 What Is It

Activity 1
Directions: Fill out the information sheet correctly.

1. Name

Surname First Name Middle Name

2. Address

Number and Street Town

City/Province Country

3. Personal Data

Age Sex Status Citizenship

Date of Birth Place of Birth

4. Parents

Father’s Name Occupation

Mother’s Name Occupation

What’s More
Activity 2

Directions: Fill out the deposit slip below based on the given

situation.

1. Shantelle Kiarra Aguilar is the depositor. She is going to

the bank on August 7, 2021.

2. Her account number is 915-4-05248011-2

7
 3. She will deposit:

One P500 bill

Two P100 bills

Five P50 bills

Be sure to read the items carefully first before filling out the deposit

Activity 3
Directions: Practice filling out a withdrawal slip. Fill out the
information given.
Depositor: Shyvel Destor
Account Number: 044-7-66739876-0
Date: July 12, 2021
Amount to withdraw: Php 10, 000

8
 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.

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

9
 What I Can Do

Directions: Fill out the student registration form below. Use the form
provided for you.

Student Registration Form

__________________ ______________ _______________
(Last Name) (First Name) (Middle name)

Sex:_________ Date of Birth:_______________ Place of Birth______________

Address:_____________________________________________ ___________
(Number/ Street/Municipality/ City/Province) (ZIP Code)

Tel. No.____________ Cell No.____________ E-Mail________________________

Father’s Name_____________________________ Occupation________________

Mother’s Name_____________________________ Occupation________________

__________________________________________
Signature over Printed Name

10
 Assessment

You have a savings bank account and you want deposit an amount of

2, 500 pesos into it, with the following cash breakdown: three 500 pesos and

ten 100 pesos. Using the bank account number 0344- 5555- 22, complete a

cash deposit slip. Fill out the form provided to you.

11
 Answer Key
What I Know What’s More
(Answers Vary) Activity 2

What’s In
1. Bella
2. July 14, 2021

3. Three thousand pesos Activity 3

4. To buy a birthday present

5. Withdrawal Slip Form

What’s New
(Answers Vary)

What Is It Assessment
(Answers vary)

What I Can do
(Answers vary)

*Other required information will vary.

References:

Castillo, Kristine Erika C, 2016, Joy in Learning English 5

Prepared by :

JEANALD V. HERRERA
Bagong Buhay Elementary School- Victoria

12