Republic of the Philippines

UNIVERSITY OF EASTERN PHILIPPINES

University Town, Northern Samar
Web: http://uep.edu.ph ; Email: registrar@uep.edu.ph

STUDENT’S CLEARANCE

_______________ _____________
Student Number Date

NAME: ______________________________ ____________________ ______________________

Surname Given Name Middle Name

COURSE: __________________________________ Major: ________________ Year: ______

Purpose (Please Check)

1. Transcript of Records

Evaluation * Transfer Credential

Reference Graduation
Employment
_____________________________
(Printed Name & Signature)

1. SCHOOL/COLLEGE DEAN 4. ACCOUNTING OFFICE

Recommending for Clearance No Obligation/With Account of
_______________________

____________________
____________________ (Print Name & Signature
(Print Name & Signature

2. OFFICE OF STUDENT AFFAIRS 5. CASHIER’S OFFICE

No Obligation No obligation/Amount Paid
________OR No. _________ Date ______

____________________ ____________________
(Print Name & Signature
(Print Name & Signature

3. UNIVERSITY LIBRARY 6. OFFICE OF THE REGISTRAR

No Obligation Academic Record Check

____________________ ____________________
(Print Name & Signature (Print Name & Signature

*Only the certificate of transfer credential with an information copy of grades will be issued to you as an
applicant for transfer. Upon request, the Office of the University Registrar will be sent the TOR directly to the
school where you have transferred.

DOCUMENT NO: REVISION NO: EFFECTIVITY DATE:

UEP-REG-FM-009 00 September 12, 2022