PLM Form 3A (2011)

Student’s Personal and Academic Records Form

Student Number:
Course:

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila

PERSONAL INFORMATION
Print Name:
(Last Name) (First Name) (Middle Name)

Maiden Name:
Address:

Telephone No: Birthday:

Cellphone No: Birthplace:
Email Address: Civil Status:
Gender: Religion:

FAMILY BACKGROUND:
Particulars Father Mother Guardian
Name:
Address:
Contact No:
Occupation:
Office/Firm/Employer:
Office Address:
Office Phone No:

SIBLINGS/RELATIVES STUDYING/WORKING IN PLM:

Name Course/Office Position Relationship

PRELIMINARY ACADEMIC RECORDS:

Particulars Elementary High School College/University

School Attended:

Inclusive Dates:
Year Graduated:
General Average:
Degree:
Major:
Honors Received:
Remarks:

In consideration of my admission at Pamantasan ng Lungsod ng Maynila and the privileges of

a student in this institution, I hereby promise and pledge to abide by and comply with all the rules and
regulations laid down by competent authority in the University and the College or School in which I
am enrolled.
_______________________________________
Student’s Signature over Printed Name