ANGELES UNIVERSITY FOUNDATION

OFFICE OF THE UNIVERSITY REGISTRAR

CLEARANCE
.
PLEASE PRINT
Date Requested Date Due OR #
Personal Information Academic Information Contact Information
Last Name: TABLA ID NO.: 17-0812-166 Tel.No./Cell No.: 09674010262
First Name: ALTREB JAYME Course: SCRIM Email Address: altrebjaymentabla.09@gmail.com
Middle Name: School term last attended:
NOGOY 1st Sem/Tri 2nd Sem/Tri 3rd Tri/Summer AY: _________
Address:

APPLICATION FOR PURPOSE CLEARANCE CERTIFICATION

(Please check.) (Please check) (Please clear with the offices below.)
[ ] Transfer Credentials [✔ ] Transfer to other School OFFICE SIGNATURE REMARKS DATE
[✔] Transcript of Records [ ] Employment Dept. Chair _________________ _____________ ___/___/___
[ ] Diploma [ ] Scholarship Dean _________________ _____________ ___/___/___
[✔] Certification [ ] Reference Library _________________ _____________ ___/___/___
[ ] Board Exam/PRC Registrar _________________ _____________ ___/___/___
[ ] Evaluation Accounting _________________ _____________ ___/___/___
[ ] Others: ____________

CLAIMING INSTRUCTIONS
Pick-up. Owner to pick-up the document and present one valid ID.
Proxy. Representative to claim the document and present the ff: an authorization
letter from the owner of the records, one owner’s valid ID and one representative’s valid ID.
_______________________________________________
Signature of Student/Graduate or Authorized Representative
Note: Accomplish one copy only: University Registrar

AUF-Form-RO-24
October 3, 2011– Rev. 02

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ANGELES UNIVERSITY FOUNDATION

OFFICE OF THE UNIVERSITY REGISTRAR

CLEARANCE
PLEASE PRINT
Date Requested Date Due OR #
Personal Information Academic Information Contact Information
Last Name: TABLA ID NO.: 17-0812-166 Tel.No./Cell No.: 09669601905
First Name: ALTREB JAYME Course: BSCRIM Email Address: tyrine1069@yahoo.com.ph
Middle Name: School term last attended:
NOGOY 1st Sem/Tri 2nd Sem/Tri 3rd Tri/Summer AY: ____________
Address:

APPLICATION FOR PURPOSE CLEARANCE CERTIFICATION

(Please check.) (Please check) (Please clear with the offices below.)
[ ] Transfer Credentials [✔ ] Transfer to other School OFFICE SIGNATURE REMARKS DATE
[✔] Transcript of Records [ ] Employment Dept. Chair _________________ _____________ ___/___/___
[ ] Diploma [ ] Scholarship Dean _________________ _____________ ___/___/___
[✔] Certification [ ] Reference Library _________________ _____________ ___/___/___
[ ] Board Exam/PRC Registrar _________________ _____________ ___/___/___
[ ] Evaluation Accounting _________________ _____________ ___/___/___
[ ] Others: ____________

CLAIMING INSTRUCTIONS
Pick-up. Owner to pick-up the document and present one valid ID.
Proxy. Representative to claim the document and present the ff: an authorization
letter from the owner of the records, one owner’s valid ID and one representative’s valid ID.
_______________________________________________
Signature of Student/Graduate or Authorized Representative
Note: Accomplish one copy only: University Registrar

AUF-Form-RO-24
October 3, 2011– Rev. 02