UNIVERSITY OF THE PHILIPPINES LOS BAÑOS

Office of the University Registrar

APPLICATION FOR OFFICIAL TRANSCRIPT OF RECORDS AND CERTIFICATIONS
Note: Official Transcript of Records (OTR) and certifications are released only upon submission of a duly approved University clearance. If the
applicant is not the party concerned, a SIGNED authorization letter and photocopy of valid ID from the latter, along with a valid ID of the
authorized representative are required before the request for documents can be accommodated.

Processing Time Fee

OTR First Issuance 4 weeks after request is filed P50.00 per page

Peak Period (July-September) 5-6 weeks

Recopy-Update 1 week

Certifications 3-5 days P30.00/copy

Certified True Copy of OTR 3-5 days P40.00/page

Certified True Copy of Diploma 3-5 days P40.00/copy

Diploma Translation 3-5 days P50.00/copy

*Unclaimed OTRs/certifications are shredded one (1) year after request is made

Date of Application: ________________________

Please tick appropriate spaces for document/s being requested and indicate number of copies requested:
OTR first request recopy
Certification
Certificate of Graduation
English as Medium of Instruction
___________________________
Purpose of Application:
Passport size For Board/Licensure Examinations For Employment
picture, white For Further Studies For DFA requirements
background w/ Others ________________________
name on
Required only for licensure exam applicants
bottom portion

For OTR/documents to be placed in a sealed envelope please indicate complete name and address of addressee:
_________________________________________________________________________

_________________________________
_________________________________
Contact No. _______________________
PERSONAL INFORMATION (please PRINT legibly)
(If married, please encircle maiden name)
_______________________ ____________________________ _______________________
Last Name Given Name Middle Name
Sex _____ Student Number ____________
Permanent Address ______________________________________________________________________________
Tel. Number ____________ Cell phone Number ______________ E-mail address _______________________
Date of Birth ______________ Place of Birth __________________
Father’s Name _____________________________ Mother’s Maiden Name _____________________________
ACADEMIC INFORMATION
Semester/Year Admitted ____________________
Admitted as New Freshman Transferee Non-degree Second degree
 MS PhD
Last Semester/Summer Enrolled at UPLB __________________________
Degree(s)/Title(s) earned at UPLB ____________________________ Major/Specialization ______________________
Classification Transferred Graduated Currently enrolled Graduating
Schools Attended Name Location Course Date of Graduation
High School __________________________________________________________________________________
College __________________________________________________________________________________
Master’s __________________________________________________________________________________
PhD __________________________________________________________________________________
Cross-registered in other UP units? Yes No
If yes, indicate UP campus _____________ Semester attended______________ Subject(s) taken _______________