CLEARANCE FORMOffice Of Registrar | P.O.Box 36711 Lusaka, Zambia | +260 976075850 / +260 953688533 | +260976200094
[email protected] | [email protected] | [email protected]
U n i v e r s i t y o f L U s a k a
(1) STUDENT INFORMATION
Names (Mr/Mrs/Ms/Dr):_________________________________________________________________
Student No:____________________________________Cell____________________________________
Email:________________________________________________________________________________
Reason for clearance (Tick):
Withdrawing Transferring
Graduation CertificateCollection
APPROVED BY :_______________________________________________________________________
SCHOOL HOD: I__________________________________________________certify that the student has
cleared and submitted the dissertation as required by the University. SIGNATURE____________________
LIBRARIAN: I____________________________________________________ certify that the above
student has returned all material to the University. SIGNATURE____________________
ACCOUNTANT: I__________________________________________________ ceritify that the student
does not owe the Unversity any fees. SIGNATURE____________________
ACADEMIC OFFICES: I________________________________________________certify that the
above student has satisfied all the above requirements and has returned the student identity card to the
University. SIGNATURE____________________
(2) OFFICIAL USE ONLY
DATE STAMP