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OFFICE OF THE UNIVERSITY REGISTRAR
University of the Philippines Diliman
Quezon City
(TOR Trust Fund A Code No. 9774700)
CLAIM STUB NO.:
DUE DATE*
Note: Please PRINT your name
and address.
Thank you.
Encoder & Checker:
Required only for bar/board applicants
APPLICATION FOR:
No. of Copies
Transcript of Records (TOR)
Certificates/Documents:
Graduation (COG)
Course Descriptions (CD)
Eng. as a Medium of Instr. Cert. (EMI)
EMI Purpose:
EMI Country:
No Objection Letter
English translation of Diploma
(Pls. attach photocopy of diploma)
High School Card/F 137
Official Envelope:
(CAV) Certification, Authentication [ ] Small
& Verification (DFA for Red Ribbon)
[ ] Medium
Certified True Copy: [ ] Large
Mailing Fee: (__Local __Abroad) DATE
OTHERS: AMT PAID
TOTAL AMOUNT TO PAY O.R. NO.
PURPOSE OF APPLICATION [Pls. check):
Employment [ ]
[ ] Local [ ] Abroad [ ] Bar Exam
Scholarship [ ]
[ ] Local [ ] Abroad [ ] PRC Licensure Exam:
Enrollment [ ]
[ ] Local [ ] Abroad [ ] LAE School:
CAV/Red Ribbon/DFA [ ] Yes [ ] No [ ] MED School:
[ ] Transfer to other School (to apply Honorobale Dismissal)
[ ] COPY FOR: (To sign an Agreement Form)
[ ] Others
NAME OF STUDENT
(Please Print Legibly) LAST FIRST MIDDLE MAIDEN
(Based on birth certificate; If married, encircle family name used during last enrollment in U.P.)
PERMANENT ADDRESS:
STUDENT NO.: FATHER'S NAME:
MOTHER'S MAIDEN NAME:
DATE OF BIRTH (Student):
PLACE OF BIRTH (Student):
PLEASE CHECK:
To be picked up personally (unclaimed TORs/COGs within 6 months are shredded)
To be mailed to the following address (es)
(If more than one, attach mailing list)
CONTACT NO. OF THE RECIPIENT:
VERY IMPORTANT: Please indicate name of last/previous school attended.
Signature of Student: Tel/Mobile No.:
EMAIL:
If representative is filing the application for the student, please furnish the following information:
Name of Representative:
Signature: Tel/Mobile No.:
Complete Address: EMAIL:
REV. jmbua 03.11.2022
Assessment/By:
IMPORTANT: For 1st time, Newly Graduate or Updating Application for Transcript of
Records & other Documents must be accompanied by a University Clearance
2 X 2
or
grad
picture
IMPORTANT: For 1st time, Newly Graduate or Updating Application for Transcript of
Records & other Documents must be accompanied by a University Clearance
RATES:
Transcript of Records (with Additional mandatory
two (2) pages for Transcript Guide)
Php50.00/page
Application from abroad
US$30.00 (inclusive of Registered Mail only)
COG/NOL/CAV/EMI
Php30.00/copy
Course Description
Php30.00/page
English Translation of Diploma & HSC/F-137
Php50.00/copy
Certified True Copy Of OTR
Php100.00/set
Certified True Copy of COG
Php15.00/copy
Certified True Copy of Course Description
Php15.00/page
Certified True Copy of Diploma Translation
Php25.00/copy
Official Envelope -small Php10.00
-medium Php15.00
-large Php20.00
NOTES: 1) After paying the application fee, submit your application and O.R. to the TS Counter. You will be issued a CLAIM STUB
[together with the O.R.], to be presented in claiming your document/s.
2) In compliance with R.A. No. 10173 (DATA PRIVACY ACT OF 2012), representative must submit a signed authorization letter with
original valid I.D. of both owner/student and representative upon claiming the requested documents.
2 X 2
or
grad
picture
COLLEGE(S)/UNIT(S) ATTENDED IN UP
DEGREE/MAJOR
INCLUSIVE DATE/S
DATE OF GRADUATION
Inclusive Semester/
year attended
High Sch./Senior H.S.
Undergraduate / Bachelor's
Program
Master's Program
Ph.D. /Doctoral Program
DATE OF
GRADUATION
Cross-Enrolled/Exchange Stud.
Note: To be checked only by O.U.R. Staff
Freeform/Manual Module
[ ] 1st time
[ ] Updating
[ ] Recopy
To Apply University Clearance
Currently Enrolled (need copy of F5/paid on CRS)
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Completed 21 March 2022

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