RAFAELITES ACADEMY OF TARLAC INC.

Pag- asa San Rafael, Tarlac City

TARLAC NATIONAL HIGH SCHOOL

Macabulos Drive, 2300 Tarlac City

Dear Sir/Ma’am,

Most respectfully, this is to inform you that Jesse J. Espinosa III with LRN NO.
489503150037 failed to settle due tuition, other school fees and other obligations at Rafaelites
Academy of Tarlac Inc. Please be informed that our school cannot release the learner’s form 137
until all charges are fully paid. However, a copy of his form 138 is attached in this letter for
admission purposes. Please contact us if in case that the original form 138 is needed. If you require
any further information do not hesitate to contact us.

Sincerely,

Soledad Calma
School Directress

Rafaelites Academy of Tarlac INC.

Pag-asa, San Rafael, Tarlac City
Mobile No. : 09212497521
RAFAELITES ACADEMY OF TARLAC INC.
Pag- asa San Rafael, Tarlac City
 RAFAELITES ACADEMY OF TARLAC INC.
Pag- asa San Rafael, Tarlac City

DEBT SETTLEMENT AGREEMENT

Student Name:_______________________________________LRN NO:________________________

By signing this Agreement I ________________________________ Parent/Guardian of the student

stated above, acknowledge and reaffirm my outstanding debt pertaining to fees of PHP_____________
with Rafaelites Academy of Tarlac INC. as of ________________________.

By signing this agreement I agree to pay my outstanding debt according to the following schedule, terms
and conditions:

1. I agree and accept responsibility for monthly payments of at least PHP_________________.

Payments are due before __________ of each month and will continue until the account is paid in full.

2. I understand it is my responsibility to notify Rafaelites Academy of Tarlac INC. of any address, phone,
name, or email changes. Notification must be promptly made to Mrs. Soledad Calma at RATI Pag-asa,San
Rafael Tarlac City , Mobile 09212497521.

3. I understand that the school authorities shall have the following rights against students with financial
obligations, which remain due and unsettled to their schools: (a)To withhold the release of the grades of
a student with delinquent account until the unpaid tuition and other school fees plus interest charges are
fully paid; (b)To deny admission or enrollment of any student having unsettled tuition or other school fees
at the next succeeding semester classes, in the case of higher education, or at the next succeeding short-
term course, in the case of post-secondary tech-voc education, as the case may be, until the previous
delinquencies are fully paid; and (c)To refuse issuance of school clearance to students with financial
obligations to the school until all previous delinquencies are fully paid.

4. I understand that I may make additional payments beyond the agreed monthly payment at any time;
however, I am still responsible for continuing to make the minimum monthly payment;

5. I further understand and agree that if I do not follow through with any portions of the above- stated
schedule of payments, terms and conditions, I promise to pay all attorney fees and other reasonable
collection costs and charges necessary for the collection of any amount not paid when due.
I have carefully and completely read this agreement and fully understand the purpose, intent and effect
of this agreement. I have voluntarily executed the agreement by action of my own free will.

Date______________________

Parent’s Signature over Printed Name _________________________________________

Address
___________________________________________________________________________________

Home No. _______________________ Cell No._______________________

Work No._______________________

Email Address____________________________