Republic of the Philippines _______________________________________

Department of Education Name and Signature of Borrower:

LCD POJECTOR BORROWER’S FORM Approved:

___________ ____________
Date & Time Borrowed: ____________________________
Principal III
Date & Time Returned: ____________________________

AGREEMENT: I acknowledge the receipt of the above **Remarks: __________________________

equipment and take full responsibility for its maintenance
and order; to return the equipment in good condition; pay
for any damage/loss caused by negligence, mishandling or
vandalism.
Republic of the Philippines
Department of Education
_______________________________________
Name and Signature of Borrower: LCD POJECTOR BORROWER’S FORM

Approved: Date & Time Borrowed: ____________________________

___________ ____________ Date & Time Returned: ____________________________

Principal III AGREEMENT: I acknowledge the receipt of the above
equipment and take full responsibility for its maintenance
and order; to return the equipment in good condition; pay
**Remarks: __________________________
for any damage/loss caused by negligence, mishandling or
vandalism.

Republic of the Philippines _______________________________________

Department of Education Name and Signature of Borrower:

LCD POJECTOR BORROWER’S FORM Approved:

___________ ____________
Date & Time Borrowed: ____________________________
Principal III
Date & Time Returned: ____________________________

AGREEMENT: I acknowledge the receipt of the above **Remarks: __________________________

equipment and take full responsibility for its maintenance
and order; to return the equipment in good condition; pay
for any damage/loss caused by negligence, mishandling or
vandalism.

_______________________________________
Name and Signature of Borrower:

Approved:

___________
Principal III

Date & Time Returned: ____________________________

AGREEMENT: I acknowledge the receipt of the above

equipment and take full responsibility for its maintenance
and order; to return the equipment in good condition; pay
for any damage/loss caused by negligence, mishandling or
vandalism.