DepEd Bataan – Form 6 Clearance

1 Personal Info

2 Employment Details

3 Clearance Requirements

4 Certification & Signatures

✔ Form entries saved successfully. Please proceed to print and submit to your school head.

👤

I. Personal Information

Employee details as appearing in official DepEd records

* Fields marked with asterisk are required

Last Name *

First Name *

Middle Name

Name Extension

Sex *

Date of Birth

Civil Status

Address *

Contact Number

Email Address

🏫

II. Employment Details

Current assignment and separation information

Employee ID No. *

GSIS BP No.

Position / Designation *

Salary Grade

Step Increment

School / Office *

District

Date of Original Appointment

Date of Last Promotion

Effectivity Date of Separation *

Nature of Separation / Transfer *

📋

III. Clearance Requirements

To be accomplished by concerned offices — check (✔) when cleared and affix signature

ℹ️ All accountabilities must be settled before this clearance is approved. Each concerned officer must sign and date the corresponding row. The employee must personally secure signatures from each office.

#	Accountability / Requirement	Concerned Office / Officer	Type
1	Money and Property Accountabilities (Equipment, Furniture, Supplies)	Property Custodian / Supply Officer	Required
2	Government-Issued ICT Equipment and Devices	ICT Coordinator	Required
3	Unused / Unutilized Leave Credits and Leave Cards	Administrative Officer / HRMO	Required
4	GSIS Loans and Premium Contributions	Finance Officer / Designated GSIS Liaison	Required
5	Pag-IBIG Fund Obligations	Finance Officer / Pag-IBIG Liaison	Required
6	PhilHealth Contributions and Records	Finance Officer / PhilHealth Liaison	Required
7	Cash Advance / Unliquidated Obligations	Accountant / Cashier	Required
8	Official Receipts and Financial Collections	School Treasurer / Cashier	Required
9	School / Office Records, Files and Registries	Records Officer / Division Registrar	Required
10	Library Books, References and Instructional Materials	Librarian / Library-In-Charge	Required
11	Laboratory / Workshop Equipment and Materials	Laboratory In-Charge / Dept. Head	Required
12	Classroom, Room and Physical Facilities	Building Administrator / Principal	Required
13	Learner Assessment Records / Grade Completion	School Registrar / Class Adviser	Required
14	Co-Curricular, Club and SSG Obligations	Club Adviser / ASP / SSG Coordinator	Required
15	Pending Administrative and Criminal Cases	Legal Officer / Division Office	Required
16	School Canteen / Food Service Obligations	Canteen Manager / SBM Chair	Optional
17	Division / District Service Committee Obligations	Division / District In-Charge	Optional
18	Deped Email / LIS / HRIS / IS Accounts	IT Officer / LIS Coordinator	Optional
19			Optional

Remarks / Findings / Unresolved Accountabilities

✍️

IV. Certification & Signatories

Official attestation by authorized DepEd Bataan officials

This is to certify that [Name of Employee] has been duly cleared of all money, property, and other accountabilities in this school / office, and that all requirements pertaining to the nature of separation have been complied with in accordance with existing DepEd rules and regulations, Civil Service Commission (CSC) issuances, and the provisions of the Schools Division of Bataan.

Date Filed *

Date Approved

Control / Reference No.

Employee

School Head / Principal

Schools Division Superintendent

⚠️ Important: This form must be submitted in triplicate. Original copy for the Division Office; Duplicate for the Employee; Triplicate for the School / Office. Falsification of entries in this document is a criminal offense punishable under the Revised Penal Code and existing DepEd issuances. This clearance is valid only when all signatories have affixed their signatures.