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    General Clearance

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    Sepha Brion
    This document is a general clearance form from the Polytechnic University of the Philippines for a graduating student. It provides details of the student such as name, student number, date of birth, academic program, and contact information. It also lists the credentials/documents requested and shows clearance from various university offices. It specifies that the student's ID must be surrendered and a claim stub presented to pick up requested records. It outlines requirements for assigned representatives to claim credentials on behalf of the student.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    General Clearance

    Uploaded by

    Sepha Brion
    51 views1 page
    This document is a general clearance form from the Polytechnic University of the Philippines for a graduating student. It provides details of the student such as name, student number, date of birth, academic program, and contact information. It also lists the credentials/documents requested and shows clearance from various university offices. It specifies that the student's ID must be surrendered and a claim stub presented to pick up requested records. It outlines requirements for assigned representatives to claim credentials on behalf of the student.

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    General_Clearance

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    This document is a general clearance form from the Polytechnic University of the Philippines for a graduating student. It provides details of the student such as name, student number, date of birth, academic program, and contact information. It also lists the credentials/documents requested and shows clearance from various university offices. It specifies that the student's ID must be surrendered and a claim stub presented to pick up requested records. It outlines requirements for assigned representatives to claim credentials on behalf of the student.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views1 page

    General Clearance

    Uploaded by

    Sepha Brion
    This document is a general clearance form from the Polytechnic University of the Philippines for a graduating student. It provides details of the student such as name, student number, date of birth, academic program, and contact information. It also lists the credentials/documents requested and shows clearance from various university offices. It specifies that the student's ID must be surrendered and a claim stub presented to pick up requested records. It outlines requirements for assigned representatives to claim credentials on behalf of the student.

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    © All Rights Reserved
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    PUP-GCGS-5-UNRO-021

    POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Rev. 0


    Office of the University Registrar May 15, 2018
    Sta. Mesa, Manila; 716-7832 to 45 local 285/293/389/343

    GENERAL CLEARANCE
    (For Graduating Students Only)

    Student Number Date of Filing Date of Graduation in PUP


    2018-10319-MN-0
    Name Academic Program
    TELAN, DHAILA JOSEPHA BIRION BSPSY
    Date of Birth Admitted in PUP
    09/27/1999 School Year: 1819 Semester: First
    Name of Elementary School Year Graduated
    DOMINICAN SCHOOL MANILA 2012
    Name of High School Year Graduated
    DOMINICAN SCHOOL MANILA 2016
    Permanent Address Contact Number
    3487 F. AGUILAR STREET, BO. OBRERO, TONDO, MANILA 9173710346

    Student Credentials/Documents Requested


    Transcript of Records Diploma
    Certification of Graduation Other _____________________

    The above-named applicant is cleared of all money and property responsibilities in my office.
    Library cleared Accounting/Student Services cleared
    College-based Laboratory cleared Office of Student Service cleared
    NSTP (ROTC/CWTS) cleared Alumni/Tahanan ng Alumni (optional)
    CHK/P.E. (GYM) cleared Dean/Director cleared
    Legal Office cleared Career Dev't. & Placement Office cleared
    Internal Audit cleared

    Requirements when claiming credentials:


    1. PUP Student I.D. (to be surrendered)
    2. Claim Stub

    All requested credentials will be released to the following assigned representatives other than the student/client:
    PARENTS/SIBLINGS/SPOUSE/CHILDREN - with formal authorization letter duly signed by the student with two (2) valid ID's
    with picture of both the student/client and the representative and photo copy of the representative's PSA (NSO) Birth Certificate
    and PSA (NSO) marriage contract for the spouse.
    REPRESENTATIVE OTHER THAN THE IMMEDIATE FAMILY - with Special Power of Attorney from the student concerned,
    duly notarized in the country/place of residence and two (2) valid ID's with picture of both.

    _______________________________________________ Client Services Info. Couter Clerk ___________________


    Signature of Applicant/Representative over Printed Name Date ___________________

    Date: 08/09/2022

    TELAN DHAILA JOSEPHA BIRION


    Last Name First Name Middle Name
    College/Campus Academic Program Date of Graduation
    Manila BSPSY

    Please claim your request for Transcript of Records Certification of Graduation Diploma
    on ____________________________ if records are complete

    Requirements when claiming credentials:


    1. PUP Student I.D. (to be surrendered) _____________________________________
    2. Claim Stub Client Services Info. Counter Clerk
    All requested credentials will be released to the following assigned representatives other than
    the student/client:
    PARENTS/SIBLINGS/SPOUSE/CHILDREN - with formal authorization letter duly signed GC-CSSD-004607
    by the student with two (2) valid ID's with picture of both the student/client and the
    representative and photo copy of the representative's PSA (NSO) Birth Certificate and PSA
    (NSO) marriage contract for the spouse.
    REPRESENTATIVE OTHER THAN THE IMMEDIATE FAMILY - with Special Power of
    Attorney from the student concerned, duly notarized in the country/place of residence and
    two (2) valid ID's with picture of both.

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