Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila
Telephone No. 8643-2562

OFFICE OF STUDENT DEVELOPMENT AND SERVICES

Certificate of Good Moral Character (GMC)

REQUEST FORM

Date of Filing : ____________________________

Date of Release : ____________________________
Student Number : ____________________________

Name : _______________________ __________________________ ___________________

Last Name First Name Middle
Name

Gender
Status
Complete Maiden Name (for married women)
Date of Graduation at PLM
Inclusive Years of Stay at PLM (1st and last enrolment)
Degree Program (please spell out your course)
College (please write in full)
Contact Number/Landline/Cell Phone Number
Purpose for Securing a Certificate of GMC
: _________________________________________
: _________________________________________
: _________________________________________
: _________________________________________
: _________________________________________
: _________________________________________
: _________________________________________
: _________________________________________
: _________________________________________

I hereby authorize the Office of the Student Development and Services (OSDS) to collect and obtain information about my
personal and academic records, in accordance with the Data Privacy Act and its Implementing Rules and Regulations (IRR),
as requirement for the processing of the certificate of Good Moral Character (GMC).

_________________________________________________
Signature of Requestor/Authorized Representative

PLEASE FILL OUT AFTER PAYMENT:

Number of Copies: _________________ Official Receipt : _________________
Date of Payment: _________________ Amount Paid : _________________

Note:
1. Claimant must present two (2) valid Identification Cards (IDs) while authorized representatives must bring with them a letter of
authorization aside from the two (2) valid IDs for purposes of filing and securing the GMC Certificate.
2. The copy of GMC Certificate shall be released three (3) working days from the date of filing.

CLAIM STUB
Certificate of Good Moral Character (GMC)

Date of Release : ____________________________________

Name of Claimant/Authorized Representative : ____________________________________
Identification Cards Presented : ____________________________________

For inquiries, please call OSDS

at telephone no. 8643-2562.
________________________________________
Dean, OSDS
Note:
1. Claimant must present two (2) valid Identification Cards (IDs) while authorized representatives must bring with them a letter of
authorization aside from the two (2) valid IDs for purposes of filing and securing the GMC Certificate.
2. The copy of GMC Certificate shall be released three (3) working days from the date of filing.