OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS

STUDENT REGISTRATION AND RECORDS OFFICE

Control No:_______________

Name of Student: ____________________________________ Course: ____________ Major: ______________

Student No.: ___________ Contact No.: ____________ Year Graduated: _________ Last S/Y Attended:________

Credentials (Pls. Check) Requirements: Additional Requirements (if applicable):

Transcript of Records - 1 pc. Picture (1.5” x 1.5”) _____ Student’s Clearance

(Processing days: 7 Working days)
Certification
(Processing days: 5 Working days)
Pls. specify:
________________________________
Acad. Year: ______________________
Semester(s): _____________________
Certification, Authentica-
tion & Verification (CAV)
(Processing days: 5 Working days)
Reconstructed Diploma
(Processing days: 5 Working days)
Authentication
(Processing day: 1 Working day)
- 2 pcs. Documentary Stamp
- Brown Envelope (long)
- 2 pcs. Documentary Stamps
- Original and photocopies
of TOR, Diploma and
Certification (if any)
- Brown Envelope (long)
- Affidavit of Loss
- Original and photocopies of
credentials for authentication
_____ Authorization letter & IDs (photocopy only) of the
requesting parties
Processed by: _________________________
Date & time received: _________________________
Date & time processed: _________________________
Date & time released: _________________________
Checked by: _________________________
Date & time received: _________________________
Date & time checked: _________________________
Date & time released: _________________________
Certified by: _________________________
Date & time received: _________________________
Date & time checked: _________________________
Date & time released: _________________________

Purpose: ___________________________________________________ Date Filed: ____________ Tentative Date of Release: _____________

_____________________________________
(Printed Name & Signature of Receiving Clerk)

--------------------------------------------------------------------------------------------------------------------
Control No:_______________

Name of Student: _____________________________________ Course: ____________ Major: _______________

Student No.: ___________ Contact No.: _____________ Year Graduated: _________ Last S/Y Attended:_________
Requested Credential(s): Submitted Requirements:
________ Student’s Clearance
________ Picture (1.5” x 1.5”)
Purpose: ________ 2 Pcs. Documentary Stamps
________ Brown Envelope (long)
________ Affidavit of Loss
Date Filed:____________ Tentative Date of Release: :_____________ ________ Receipt of Payment(s)
IMPORTANT REMINDER: Per Data Privacy Law of 2012 (R.A. 10173), authorized representative
may request and/or claim applicant’s credentials upon presentation of
the following: (1) Authorization letter from the applicant with his/her
signature; (2) Photocopy of the applicants’ valid ID with his/her picture
and signature; and (3) Photocopy of the representative’s valid ID with _____________________________________
his/her picture and signature. (Printed Name & Signature of Receiving Clerk)
BISCAST-F-SRR-04
September 2019 Rev. 2 Page 1 of 1