Republic Of The Philippines

MINDANAO STATE UNIVERSITY

Marawi City

Office Of The Registrar

UNIVERSITY CLEARANCE FORM FOR STUDENT

TO WHOM IT MAY CONCERN :

I _______________________________ a bonafide of the College of ______________________________ in

Mindanao State University, Marawi City wish to apply for clearance of all money and property University
Clearance is being requested for the purpose/s listed hereunder:

1. ______________________ 3.____________________
2. ______________________

HOME ADDRESS : ________________________________________________

First Admission to MSU: Semester last attended: ID No.:_______________

_____sem,____________ _______sem,__________
The above named student has been cleared from all money and property accountabilities:

____________________ _____________________ _________________________

University Book Center University Literarian Supervising Residence Head

____________________ ______________________ __________________________

Laboratory Custodian Auxiliary Services Accounting Service

____________________ _______________________ ___________________________

College of Information Tech University Infirmary Division of Student Affairs

____________________________ ____________________________
Colllege of SPEAR Department Dean of College

FOR GRADUATING STUDENT ONLY (after graduation)

a) _____________________ b) ________________________
Property Office Director

FORM 137A/TOR/Other School Credentials verified on File: _________________________

Register’s Office

APPROVED:
IBRAHIM D. MANGONDATO,Ph.D.
University Registrar

NOTE: To be prepared in two (2) copies,Original Copy- Registrar’s Office, Photocopy – Student’ copy must be
presented while claiming the diploma and /or any school record.