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Mesa, Manila PUPCET School Year 2010-2011 APPLICANT’S COPY Name: Jose Carlo Dimen Motita Reference Number: 2010-0002-3688 This is your copy. Keep this part in a safe place. Present this document when you claim your Test Permit. This document is valid only until December 09, 2009. ALL FEES ARE NONREFUNDABLE. I expressly agree to the Terms of Use, have read and understand the Privacy Policy, and confirm that the information that I have provided to the University are true and correct to the best of my knowledge. My submission of this form will constitute my consent to the collection and use of my information and the transfer of information for processing and storage by PUPWebSite and Polytechnic University of the Philippines. Furthermore, I agree and understand that I am legally responsible for the information I entered in PUP iApply System and if I violate its Terms of Service my information may be removed and lead to the termination, without prior notice, of my application and everything associated with it, including my personal information. Applicant’s Signature:

2010-0002-3688 Application Fee: PHP 500.00 Bank Service Fee: PHP 25.00

Republic of the Philippines POLYTECHNIC UNIVERSITY OF THE PHILIPPINES Sta. Mesa, Manila PUPCET School Year 2010-2011 BANK’S COPY Name: Jose Carlo Dimen Motita Reference Number: 2010-0002-3688 This is the Bank’s copy. Detach this part and present it to the Bank Teller (together with the bank’s fully-accomplished deposit slip) when you pay the Application Fee. This document is valid only until December 09, 2009 .

CERTIFICATION OF GRADES (To be filled out by the Principal/Registrar of the School) TO: POLYTECHNIC UNIVERSITY OF THE PHILIPPINES ATTENTION: ADMISSION AND REGISTRATION OFFICE Date: __________________________________ In connection with the application of: _____________________________________________________________________________ __________ a bona fide student currently enrolled this SY __________________ to apply/take the PUPCET for SY 2010-2011, I hereby certify that his/her General High School Weighted Average is as follows during his/her studies in this school: School Year Taken General Weighted Average First Year: Second Year: Third Year: High School (where the student completed/completing secondary level of education. Name of High School (Do not abbreviate) : Former name (if any) : High School Mailing Address Number and Street: Subdivision/Village: Barangay/Town: City/Province:

This certification is issued for the approval of his/her PUPCET Application purposes. Date Established: ________________________ Recognized/Accredited by DepEd: ____________________ (Contact Numbers) Landline: _______________________________ Mobile: _________________________ Fax No: ________________________________ Email Address:___________________________________ High School Type: ___ Public General ___ Public Science ___ Public Vocational ___ Public Barrio/Barangay ___ State University/College ___ Private ___ Others, please specify: ________________ Type/s of Curriculum: ___ General Education / New Secondary Education ___ Science-oriented ___ Vocational-Technical ___ ACE (Accelerated Christian Education) ___ Special Programs for the Arts ___ Basic Education (Revised Basic Education) ___ Others, please specify: ________________

____________________________________________________ High School Principal / Registrar (Signature over printed name) (School dry seal) Checklist: What to do next? We have provided you with this checklist on what you are to do next. Follow through these instructions to finalize your application. Print this document: You need to print this document because you will present this when you pay the Application Fee and claim your Examination Permit. Certification of Grades: Go to the Office of the School Registrar where you are currently enrolled and request for the certification of your high school weighted average in the First Year, Second Year and Third Year. A certification form is printed on the lower portion of the Payment Voucher that you printed. Request your School Registrar to fill-up and sign the form with the school seal. Pay the Application Fee: You can pay at any Land Bank of the Philippines (LANDBANK) branch nearest you. ALL FEES ARE NON-REFUNDABLE. Thru LANDBANK: 1. Go to the nearest LANDBANK Branch nationwide to remit payment via ONLINE COLLECTION. 2. Fill-up three (3) copies of Deposit Slip with your FULL NAME, Reference Number, and Amount to be paid (as indicated in the provided payment voucher). Distribution of Deposit Slip shall be as follows: ○ Original - Accepting Branch

Duplicate and Triplicate - Payor Copy

3. Detach the Bank Copy of the provided Payment Voucher. 4. Present to the LANDBANK teller duly accomplished Deposit Slip with your payment. 5. After processing your payment, the LANDBANK Teller will give you the duplicate and triplicate copy of the Deposit Slip. Keep it together with the Applicant Copy of the Printed Payment Voucher. Please allow two to three (2-3) working days before claiming your Test Permit. Claim your Examination Permit

Go to the Admissions Office inside the Sta. Mesa, Manila campus Present the following to the Admission Officer: Applicant's Copy of your Printed Payment Voucher; Duplicate Validated Copy of the LANDBANK Deposit Slip Certification of Grades signed by the High School Principal or Registrar showing the Applicant's General Weighted Average (GWA) in the first, second and third year.

• • • •

The Admission Officer will validate your application in their records. (Don't forget to sign your Applicant's Copy of the Printed Payment Voucher)

If validated, you will be asked to have your digital photo taken. The Admission Officer will print your Test Permit and give it to you. The Permit contains the Date, Time, and Place of your Entrance Test (and other information). You will present this Permit when you take the Entrance Test. Remember, DO NOT misplace these documents. This document Your TEST PERMIT Your duplicate validated copy of the LANDBANK Bills Payment Slip or Official Receipt

IMPORTANT, READ CAREFULLY: Keep the following in a safe place: • • •

PUP will not be held responsible for the loss of these documents that will arise from the applicant’s negligence. This form is non-transferable and is not for sale. INCOMPLETE DOCUMENTS WILL NOT BE PROCESSED.