SAMAR STATE UNIVERSITY

Arteche Blvd., Catbalogan City, Philippines 6700

Office of the University Registrar

SSU-UNREG-FR-028
04-FEB-2019 REV. 0

August 13, 2020

Date
PROMISSORY NOTE

The University Registrar

SAMAR STATE UNIVERSITY
Catbalogan City

Madam :

I , request your office to please allow me to

enroll temporarily under the Bachelor of Elementary Education due to lack of

(Course/Major)
credentials; Medical Certificate .This is also to acknowledge that the
(lacking credentials)
undersigned will not be able to claim any request made in the office as long as the lacking documents are

not yet complied.

Promise to submit the said credentials on as soon as the campus clinic is already available .

I hope for your kind consideration.

Signature over Printed Name

Contact #
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