OFFICE OF THE REGISTRAR

⬜ Manila ⬜ QC
✔

RECOGNITION/ GRADUATION RITES CLEARANCE AND

REQUEST FOR DOCUMENTS
INSTRUCTIONS: REMINDERS:
1. Fill out this form properly and clearly, 1. An authorization letter together with valid ID cards of both
2. Upload the accomplished form to this link http://bit.ly/TIPM-UploadForm_RegistrarOffice
together with the applicable requirements:
the requesting student and authorized representative must
a. 1 pc 2”x2” colored picture in Marine uniform with white background (for BSMT/BSMarE be presented, if the claimant is not the person concerned.
graduate only) 2. Transcript of Record/ Diploma / Certification not claimed
b. 1 pc 2”x2” colored picture in toga attire (without cap) with white background (for other
programs) within six (6) months from the date of application shall be
3. Secure clearance from the offices indicated in this form; discarded or cancelled.
4. For online payment, ask for a payment Reference Number from SAO OR proceed to the
Tellering Section for onsite payment.

REQUEST FOR DOCUMENT

SURNAME FIRST NAME LENIELLE MIDDLE NAME
AMATOSA BABON
STUDENT NO. PROGRAM BSCE EMAIL ADDRESS
1111444 lenielleamatosa@gmail.com
PERMANENT ADDRESS: CONTACT NO.
Santo Nino Villareal Samar 09979831411
REQUEST: (Please Check) PURPOSE: (Please Check)
◻ Diploma / Certificate ◻ Transcript of Record ◻ Licensure Exam for: __________________ ◻ Employment
◻ Certification of Graduation ◻ Others _____________________________ ◻ Apprenticeship
◻ Others: __________________________________________
The TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES, acting upon my application for recognition / graduation with the title/degree in
BACHELOR 2016
OF SCIENCES IN CIVIL ENGINEERING this academic year ____________________________
______________________________________________________________ has considered favorably offering me to
graduate subject however, to the school policies on graduation..
The School reserves the right to cancel or revoke my recognition/ graduation should my records submitted as requirements for recognition/graduation were later found to be
fraudulent..
September 04, 2021
-------------------------------------------------------------- ----------------------------------------
Signature of the Student Date

STUDENT CLEARANCE
1 OFFICE OF THE REGISTRAR (Remarks/Signature/Date)
8 STUDENT ACCOUNTING OFFICE (Remarks/Signature/Date)

Old account: PhP___________________________________

Alumni Fee: ___________________________________

2 PROGRAM CHAIR (Remarks/Signature/Date) Graduation Fee: ___________________________________

Recognition Fee: ___________________________________

Diploma/Certificate: ___________________________________
3 OFFICE OF STUDENT AFFAIRS (Remarks/Signature/Date)
Transcript of Record: ___________________________________

Certification: ___________________________________
4 LIBRARY DEPARTMENT (Remarks/Signature/Date) Transfer Credential: ___________________________________

Certificate of GMC: ___________________________________

Others: ___________________________________
5 LABORATORIES AND SHOPS DEPARTMENT (Remarks/Signature/Date)

TOTAL PhP __________________________________

6 ALUMNI & PLACEMENT OFFICE (Remarks/Signature/Date)
Verified by/Date: Audited by/Date:

7 GUIDANCE & COUNSELING CENTER (Remarks/Signature/Date) 9 TELLERING SECTION (OR Number /Signature/Date)

✂---------------------------------------------------------------------------------------------------------------------------------------------------------------
TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES
Office of the Registrar ◻ QC (Tel No.: 8-9121539) ◻ Manila (Tel No.: 8-7364208)
NAME: REQUESTED DOCUMENT(S): FOR USE OF THE PROGRAM

⬜ Diploma / Certificate CHAIR OF BOARD PROGRAM ONLY

PROGRAM: ⬜ Certification of Graduation

⬜Transcript of Record
DATE OF REQUEST:: DATE OF RELEASE:
⬜Others_____________
IMPORTANT: 1. An authorization letter together with valid ID cards of both the requesting student and authorized representative must be presented if
the claimant is not the person concerned.
2. Transcript of Record/Diploma not claimed within six (6) months from the date of application shall be discarded or cancelled.