ISO 9001:2015 CERTIFIED

BULACAN STATE UNIVERSITY

OFFICE OF THE UNIVERSITY REGISTRAR

Statement of Account

Reference Number: 210222G4DUM3KY

Date: February 22, 2021

Bill to

Student Number: 2015170695

Name: ANA RONA V. SUPAPO

Address: MABINI ST. POBLACION, PULILAN, BULACAN

Contact No.: 09068304479

Requested Document Document Fee No. of Copies Total

Certification, Authentication and Verification Php. 50.00 1 Php. 50.00

Certified True Copy - Certification Php. 25.00 1 Php. 25.00

Certified True Copy - TOR Php. 25.00 1 Php. 25.00

General Weighted Average Certificate Php. 25.00 1 Php. 25.00

Total Amount Php. 125.00

IMPORTANT NOTES

For Transcript of Records (TOR) and Certification, Authentication and Verification (CAV) requests, you must bring one (1) Documentary Stamp
for each document.

You must bring a photocopy of your TOR/Diploma for any requests on Certified True Copy of TOR and/or Diploma.

You can pickup your requested documents after 5 working days once payment has been made. Pickup schedule will only be available from
Monday-Friday at 8:00 AM to 12:00 PM.

CLAIM STUB

Date filed: February 22, 2021

To: ANA RONA V. SUPAPO Bachelor of Secondary Education

Name Course

You can pickup your requested documents after 5 working days once payment has been made. Pickup schedule will only be available from Monday-Friday
at 8:00 AM to 12:00 PM

Issued by:

Note: An authorization letter, I.D. of student and I.D. of representative must be presented if subject student is not available to receive the
requested document.