FOR UNIVERSITY CLEARANCE APPLICATION ONLY

UP Form 241 (Revised Mar 2012) (To be filled up by OSCC personnel)

PENDING ACCOUNT WITH _________________________
OFFICE OF THE UNIVERSITY REGISTRAR
UNIVERSITY OF THE PHILIPPINES - DILIMAN DATE RECEIVED _________ BY _______
One-Stop Student Clearance Center (OSCC)
TRANSCRIPT FUND B
IMPORTANT: 1. PLEASE PROVIDE ACCURATE AND COMPLETE DATA TO AVOID DELAY CODE # 9774711 - Records Section
IN PROCESSING CERTIFICATION:
2. KEEP YOUR CLEARANCE CARD WHICH YOU WILL PRESENT EACH CLEARANCE - ₱ 30.00
TIME YOU TRANSACT BUSINESS REQUIRING CLEARANCE O.R. No. : ______________________
(e.g. APPLICATION FOR TRANSCRIPT OF RECORDS, DIPLOMA, AMT. PAID : ____________________
HONORABLE DISMISSAL and CERTIFICATE OF GRADUATION). DATE : ________________________

STUDENT NO. 2 0 0 9 - 1 3 7 6 2 PURPOSE: Official Transcript of Records, Employment, Board Exam, Diploma
____________________________________________________
Certificate of Graduation
____________________________________________________
____________________________________________________

COSICO, ROOCHIE MICO, VILLALUZ

NAME _____________________________________________________________________ SIGNATURE ________________

First Semester AY 2009-2010 Engg

FIRST ENROLLMENT IN U.P. ______________________________________________________________________________
SEMESTER ACADEMIC YEAR COLLEGE

Second Semester AY 2013-2014 Engg

LAST ENROLLMENT IN U.P. ______________________________________________________________________________
SEMESTER ACADEMIC YEAR COLLEGE

YEAR GRADUATED __________________________________ DEGREE ___________________________________

1095 Rodriguez Avenue, BANGKAL, MAKATI
PRESENT ADDRESS __________________________________________________________ First Time to Apply X Yes No
09322673885 / 8865664
CONTACT NO. (Landline/Mobile phone) ______________________________ rm_cosico21@yahoo.com
E-MAIL: ____________________________________

PROCEED TO THE FOLLOWING OFFICES TO SETTLE ACADEMIC DELINQUENCIES AND/OR ACCOUNTABILITIES

You do not have any accountabilities to settle.

OFFICE OF THE UNIVERSITY REGISTRAR

Graduation Fee ₱_________________ OR# _______________ Date ________________

UNDERASSESSMENT
Nature Semester Amount OR# Date

ENTRANCE CREDENTIALS SUBMITTED

Official Transcript of Records ____________________
High School Card______________________________
F 137 _______________________________________
____________________________________________

GRADUATED IN U.P. YES NO DEGREE & DATE ____________________________

CLEARED BY

ROWENA T. ESCLANDA
OFFICER-IN-CHARGE DATE _________________
ADMISSION AND REGISTRATION SECTION AS OF _________________
2nd Sem 13-14