Republic of the Philippines

Surigao del Sur State University

Rosario, Tandag City, Surigao del Sur 8300
Telefax No. 086-214-4221
Website: www.sdssu.edu.ph

REQUEST FORM FOR DOCUMENTS

Date Requested Date Due
PERSONAL INFORMATION
Last Name Note: Please attach passport
First Name size ID Picture within the
Middle Name last 6 months, w/ name tag
& white background.
Sex
Birthday
Birthplace ACADEMIC INFORMATION
CONTACT INFORMATION ID Number
Cell Number Degree/Course
Permanent
Address
DOCUMENT TYPE Yes, I graduated on
Quantity Price Did you
Transcript of For Board Exam/PRC Purposes graduate from
Records For Employment Purposes SDSSU? No, my last
For Evaluation Purposes enrolment was
Graduation
Enrollment Term SY
Units Earned
Certificate of Transfer Credential CLEARANCE
Certification
Passed Comprehensive Exam
Cert., Authen. & Verification (CAV)
Good Moral O.R. No. Date
With Grades
Diploma Cashier Librarian III
Certified True
Transcript of Records (TOR)
Copy College Dean Supply Officer
Certification
Others Photocopy
TOTAL OSAS Adviser Registrar Records in-
charge

CLAIM STUB
Name: ____________________________________________ Course: ________________________________
Type of Documents: _________________________________ Date Requested: ____________ Date Due: _____________

(Please claim your request from the Office of the University Registrar, for queries you may contact us thru our mobile # 09300453258)

Bring the following:

1. Bring ______ Documentary Stamps worth P15.00 for TOR, Cert. & Diploma (during filing)
2. In case of representative, attach notarized authorization letter with original signature of the owner and the original and
photo copy of valid IDs of both the owner and authorized representative.
3. Original Valid IDs of representative and the requestor.
Conditions and Reminders:
1. Request will be released only on due date.
2. Request with delinquent records will not be processed unless lacking requirement/documents is attached/complied/submitted.
3. No Claim Stub, No Release.
4. In case of claim stub loss, present notarized affidavit of loss in claiming.
5. Requested Documents which remain unclaimed after 60 days will be automatically destroyed.

_________________________________ RENE Q. DIAZ, MPA, MAED

Requestor Signature overPrinted Name Registrar III

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