The document is an examination permit from Dipolog Rose Kinder School Inc. It contains information such as the student's name, age, sex, address, grade level, payment schedule signed by the teacher, and receipt numbers. The permit allows the student to take examinations and lists the payment amounts and schedule.

1. DIPOLOG ROSE KINDER SCHOOL INC. 294 Lapu-lapu Street, Estaka , Dipolog City
294 Lapu-lapu Street, Estaka , Dipolog City Tel. No. (065) 212-3639
Tel. No. (065) 212-3639
EXAMINATION PERMIT
EXAMINATION PERMIT
Date Registered :
Date Registered :
Name: Sex:_______Age:
Name: Sex:_______Age: Address: Grade Level:
Address: Grade Level: Contact No.:
Contact No.: Teacher’s
Schedule
Amount Receipt
of
Schedule Signature PAID No.
Teacher’s Amount Receipt Payments
of
Signature PAID No. 1st
Payments
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th
DIPOLOG ROSE KINDER SCHOOL INC.
DIPOLOG ROSE KINDER SCHOOL INC. 294 Lapu-lapu Street, Estaka , Dipolog City
294 Lapu-lapu Street, Estaka , Dipolog City Tel. No. (065) 212-3639
Tel. No. (065) 212-3639
EXAMINATION PERMIT
EXAMINATION PERMIT
Date Registered :
Date Registered :
Name: Sex:_______Age:
Name: Sex:_______Age: Address: Grade Level:
Address: Grade Level: Contact No.:
Contact No.: Schedule
Teacher’s Amount Receipt
Schedule of
Teacher’s Amount Receipt Signature
Payments
PAID No.
of
Signature PAID No.
Payments 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th 1st
1st 2nd
2nd 3rd
3rd 4th
4th
DIPOLOG ROSE KINDER SCHOOL INC.