FOR UNIVERSITY CLEARANCE APPLICATION ONLYUP Form 241 (Revised
Mar 2012) (To be filled up by OSCC personnel)
PENDING ACCOUNT WITH _________________________OFFICE OF THE
UNIVERSITY REGISTRARUNIVERSITY OF THE PHILIPPINES - DILIMAN DATE
RECEIVED _________ BY _______One-Stop Student Clearance Center
(OSCC)
IMPORTANT: 1. PLEASE PROVIDE ACCURATE AND COMPLETE DATA TO AVOID
DELAYIN PROCESSING
2. KEEP YOUR CLEARANCE CARD WHICH YOU WILL PRESENT EACH TIME YOU
TRANSACT BUSINESS REQUIRING CLEARANCE(e.g. APPLICATION FOR
TRANSCRIPT OF RECORDS, DIPLOMA,HONORABLE DISMISSAL and CERTIFICATE
OF GRADUATION).
STUDENT NO. 1 9 9 8 - 0 8 0 6 7 PURPOSE:
________________________________________________________________________________________________________
____________________________________________________
NAME
_____________________________________________________________________
SIGNATURE ________________
FIRST ENROLLMENT IN U.P.
______________________________________________________________________________
SEMESTER ACADEMIC YEAR COLLEGE
LAST ENROLLMENT IN U.P.
______________________________________________________________________________
SEMESTER ACADEMIC YEAR COLLEGE
YEAR GRADUATED __________________________________ DEGREE
___________________________________
PRESENT ADDRESS
__________________________________________________________ First
Time to Apply Yes NoCONTACT NO. (Landline/Mobile phone)
______________________________ E-MAIL:
____________________________________
PROCEED TO THE FOLLOWING OFFICES TO SETTLE ACADEMIC
DELINQUENCIES AND/OR ACCOUNTABILITIES
OFFICE OF THE UNIVERSITY REGISTRAR
Graduation Fee _________________ OR# _______________ Date
________________UNDERASSESSMENT
Nature Semester Amount OR# Date
ENTRANCE CREDENTIALS SUBMITTEDOfficial Transcript of Records
____________________High School Card______________________________F
137
___________________________________________________________________________________
GRADUATED IN U.P. YES NO DEGREE & DATE
____________________________
TRANSCRIPT FUND BCODE # 9774711 - Records
SectionCERTIFICATION:
CLEARANCE - 30.00O.R. No. : ______________________AMT. PAID :
____________________DATE : ________________________
CLEARED BY
ROWENA T. ESCLANDAOFFICER-IN-CHARGE
ADMISSION AND REGISTRATION SECTIONDATE _________________AS OF
_________________
SEBASTIAN, BOBBY JOHNSON, OLAVIDES
Official Transcript of Records, DiplomaCertificate of
Graduation
Second Semester AY 2014-2015 Law
First Semester AY 2003-2004 VSB
X24 7th Ave., GRACE PARK WEST, KALOOKAN CITY(SOUTH)09179007399 /
9450126 [email protected]
2nd Sem 14-15
You do not have any accountabilities to settle.
