Request For TOR UPV

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OFFICE OF THE UNIVERSITY REGISTRAR

University of the Philippines Visayas


5023 Miag-ao, Iloilo
Tel. No. (033) 315-85-56
E-mail Address: [email protected]

NOTE : Please PRINT your name and address. Thank you. Note: To be FILLED-OUT only by O.U.R. Staff
IMPORTANT: Application for Official Transcript of Records & CLAIM STUB NO.: ____________________
Certificate of Graduation must be accompanied by a DUE DATE: ____________________
DATE CLEARED : ____________________
University Clearance.

For graduates requesting for PRC Board Examination, please submit a passport size picture with white background.
The student must be wearing a shirt/blouse with collar.

APPLICATION FOR: No. of Copies


RATES
Official transcript of records (OTR) 1st time to apply? Official Transcript of Records
Authenticated copies Yes Php 50.00/page (on security paper)
Certificates: No OTR Application from abroad
Certificate of graduation (inclusive of mailing, exclusive of bank charges)
If NO, date of last
English as medium of instruction US $ 30.00 via registered mail
application:
CAV (Authentication & Verification) US $ 50.00 Asia & US via courier
________________
Course description US $ 60.00 Europe & Africa via courier
Updating
Units earned Certificates Php 40.00/page
Recopies
Bonafide student English translation of diploma Php 50.00/copy
General weighted average Computation of GWA/GPA Php 100/computation
Grade point average DATE _______________ Authentication of documents Php 20.00/page
Letter of No Objection AMT PAID ____________ Envelop Php 10.00/envelop
HD (for graduated students only) O.R. NO. ______________ Administrative cost Php 10.00
Others: Verification of Records
English Translation of Diploma (Please attach Local Php 100/student
Record verification photocopy of diploma) Application from abroad US $ 20.00
Authentication ________________ (exclusive of OTR and bank charges)
Other document _______________ Mailing fees are subject to prevailing Philippine
postal rates
PURPOSE OF APPLICATION (Pls. check):
[ ] Employment [ ] Local [ ] Abroad [ ] PRC Licensure Exam
[ ] Scholarship [ ] Local [ ] Abroad [ ] Certification, Authentication & Verification for DFA
[ ] Enrollment [ ] Local [ ] Abroad [ ] Migration
[ ] UP Visayas/UP System [ ] Records Purposes
[ ] Transfer to other school [ ] Others ________________________________________
[ ] COPY FOR (Please attach school request) _________________________________________________________________

NAME OF STUDENT ________________________________________________________________________________________


(Please Print Legibly) LAST FIRST MIDDLE
(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: ________________________________
STUDENT’S PLACE OF BIRTH: ____________________________________________________________________________
PLEASE CHECK:
To be picked up personally
To be mailed to the following address (es) ___________________________________________________________
(If more than one, attach mailing list) _______________________________________________________
Please indicate all U.P. colleges/units attended in chronological order.
UP COLLEGE(S)/UNIT(S) DEGREE/MAJOR INCLUSIVE DATES DATE OF GRADUATION
ATTENDED IN U.P.

NOTE: NON-DISCLOSURE of complete enrollment in U.P. will cause delay in processing your OTR since an UPDATED CLEARANCE IS NEEDED.
For students who transferred or obtained their degree from another school, please indicate all schools attended in
chronological order.
Name and Location of Degree/Title Obtained Inclusive Dates Date of Graduation
Institution

Signature of Student: _________________________________ Tel. No. _________________ Email _____________________


If representative is filing the application for the student, please furnish the following information:
Name of Representative: __________________________________________ Signature: _______________________________
Complete Address: _____________________________________ Tel. No. ________________ Email _____________________

NOTES: 1) After paying the application fee, submit your application and O.R. to the Office of the University Registrar.
You will be issued a CLAIM STUB (together with the O.R.) to be presented upon claiming your documents.
2) If you are a REPRESENTATIVE, present a signed authorization letter of request. Upon claiming the
requested documents, present the claim stub and your valid I.D.
JAG/alas 09012014

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