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PUP OUS General Clearance 2017

This document is a general clearance form from the Polytechnic University of the Philippines Open University System for Kristine Jane Manalastas. It provides her personal details like name, age, program of study, student number, addresses and schools attended. The form is to request her transcript of records, certificate of grades, diploma and honorable dismissal. It requires signatures from various offices in the university to clear any responsibilities before the credentials can be released.

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Weblio Jane
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569 views1 page

PUP OUS General Clearance 2017

This document is a general clearance form from the Polytechnic University of the Philippines Open University System for Kristine Jane Manalastas. It provides her personal details like name, age, program of study, student number, addresses and schools attended. The form is to request her transcript of records, certificate of grades, diploma and honorable dismissal. It requires signatures from various offices in the university to clear any responsibilities before the credentials can be released.

Uploaded by

Weblio Jane
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES 2PCS.


OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS 2X2 PICTURE IN
OPEN UNIVERSITY SYSTEM FORMAL ATTIRE
W/ WHITE
OUSR_FORM No. 1, Rvsd.
GENERAL CLEARANCE Jun2017 BACKGROUND
(for TOR and DFA
Request only)
PLEASEPRINTALLENTRIESLEGIBLY
LAST NAME: Manalastas FIRST NAME: Kristine Jane MIDDLE NAME: Marcelo
Age: 32 Sex: Femaile Civil Status: (√) Single, ( ) Married, ( ) Others ( pls. Specify) :
Degree/Program: BSBA Major in Human Resource Management School Year admitted in OUS: 2017
Student Number: 2017-09970-MN-0 Last School Year attended in OUS: 2020
Permanent Address: 545 Golden Grain Villas, Purok 3, Mojon, City of Malolos, Bulacan
Email Address: kjanemanalastas@gmail.com Telephone/Cellphone No.: 0956 688 9090
Elementary School: Holy Child Catholic School Year Graduated: 2000
High School: Marcelo H. Del Pilar National High School Year Graduated: 2005

College: La Consolacion University Year Graduated: 2009 (Under graduate)

Date of Comprehensive Examination (for advance degree programs):


Purpose of Request:
Please Check your (√) TRANSCRIPT OF RECORDS (√) CERTIFICATE OF GRADES (√) CERTIFICATE OF GRADUATION
Request: (√) DIPLOMA (√) HONORABLE DISMISSAL ( ) OTHERS:
THE ABOVE-NAMED STUDENT IS CLEARED OF ALL MONEY AND PROPERTY RESPONSIBILITIES IN MY OFFICE.
(To be signed by the duly authorized representative of the respective offices.)

NOTE: for request of TRANSCRIPT OF RECORDS, CERTIFICATION AND HONORABLE DISMISSAL,


Nos. 1 to 4 only for clearance. For graduating students, Nos. 1 to 8 to be cleared.
1. LIBRARY : 5. CHIEF, Research, Extension and Accreditation :
(3rd Floor NALLRC Bldg.) (4th Floor NALLRC Bldg.)
2. ACCTG. OFFICE : 6. PROGRAM CHAIR :
(Ground floor Main Bldg.) (4th Floor NALLRC Bldg.)
3. INTERNAL AUDIT : 7. INSTITUTE DIRECTOR :
(3rd Floor South Wing Main Bldg.) (4th Floor NALLRC Bldg.)
4. LEGAL OFFICE : 8. OUS EXECUTIVE DIRECTOR :
(3rd Floor South Wing Main Bldg.) (4th Floor NALLRC Bldg.)

Signature: Counter Clerk:


DUE DATE Date Received:

THIS CLEARANCE IS VALID ONLY FOR SIX (6) MONTHS. Date:


(CLAIM STUB)

Name: MANALASTAS KRISTINE JANE MARCELO


(Surname) (First Name) (Middle Name)
Please claim your request for on
(Requested Credentials) DUE DATE (if records are complete)
REQUIREMENTS/ DOCUMENTS SUBMITTED
1. Transcript of Record (TOR) from the last school attended/Form 137-A with Remarks “COPY FOR PUP OPEN
UNIVERSITY SYSTEM”
3. PSA Birth Certificate Original
4. PSA Marriage Contract Original (for female married students)
5. Documentary Stamp
6. Proof of Payment
NOTE:
1. PLEASE FOLLOW-UP ON TO LEARN ABOUT THE STATUS OF YOUR REQUEST/S.
2. BRING IDENTIFICATION CARDS WITH PICTURE AND SIGNATURE
3. FOR THE REPRESENTATIVE WHO WILL CLAIM THE TRANSCRIPT OF RECORDS/DIPLOMA PLEASE BRING:
Special Power of Attorney from the student and ID of the representative.
4. FOR THE REPRESENTATIVE WHO WILL CLAIM THE CERTIFICATION PLEASE BRING:
Authorization Letter with ID from the student and ID of the representative.
FOR FOLLOW –UP, PLEASE CALL THE OUS REGISTRAR AND ADMISSION OFFICE: TRUNK LINES: 335-1787/335-1777
LOCAL 325 AND DIRECT LINE: 335-1726
4th Flr. NALLRC Bldg. PUP A. Mabini Campus, Anonas Street, Sta. Mesa, Manila, Phone: (Direct Line) 3351726; (Trunk Line) 3351787 local 325;
website: www.pup.edu.ph email: ousregistrar@pup.edu.ph

“THE COUNTRY’S 1st POLYTECHNICU”

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