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REPUBLIC OF THE PHILIPPINES
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
STA. MESA, MANILA
ROILAN CAGALPIN FRANCIA
2023-0063-0295
APPLICATION INFORMATION
Reference Number:
Application Date:
Campus:
STATEMENT SUMMARY
Application Fee
This voucher is valid until:

REPUBLIC OF THE PHILIPPINES
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
STA. MESA, MANILA
ROILAN CAGALPIN FRANCIA
Application Fee
ACCOUNT NUMBER
0682-1020-47
PUP TRUST RECEIPTS
Use this Account Information
when paying to LANDBANK
PUPOUSEE 2023
For the Second Semester
Academic Year 2022-2023
APPLICANT’S COPY
This is your copy. Keep this in a safe place.
2023-0063-0295 This voucher is valid only until MARCH 30, 2023
February 02, 2023
Sta. Mesa, Manila ALL FEES ARE NONREFUNDABLE AND NONTRANSFERABLE;
hence, only those who qualify shall apply. You are allowed to
apply and take the PUPOUSEE only once this school year.
Double application will make your PUPOUSEE result null and
void.
I agree to the Terms of Use, have read and understood the
PHP 500.00 Privacy Policy, and confirm that the information I have
provided to the University are true and correct. The
submission of my PUPOUSEE application form constitutes my
consent to the collection and use by the Polytechnic University
of the Philippines (PUP) of the information I have provided as
well as the transfer for processing and storage at PUP.
Furthermore, I agree and understand that I am legally
responsible for the information I entered in the PUP iApply
System, and if I violate its Terms of Service, my information
shall be removed and shall lead to the termination, without
prior notice of my application and everything associated with
it.
I also understand that my admission in the University shall
be based on passing the PUPOUSEE cut-off score, the
interview, and meeting the University requirements on a
FIRST-COME-FIRST-SERVED basis, subject to the availability
of slots.
Applicant’s Signature
(Please refer to Page 2 of this voucher for the next set of
procedures)
MARCH 30, 2023
PUP CASHIER’S / LANDBANK COPY
PHP 500.00 The PUP CASHIER and LANDBANK is authorized to
receive payments for PUPOUSEE.
This is PUP CASHIER’s / LANDBANK’s copy. Detach this
part and present it to the Cashier/Teller when you pay
REFERENCE NUMBER DUE DATE the Application Fee.
THESE DOCUMENTS CONTAIN PERSONALLY
2023-0063-0295 MARCH 30, 2023
THIS IS YOUR REFERENCE PLEASE PAY ON OR
IDENTIFIABLE INFORMATION. TO PROTECT THE
NUMBER BEFORE THIS DATE CLIENT’S DATA PRIVACY, PLEASE KEEP AND FILE THIS
IN A SAFE LOCATION.
This is an auto-generated copy of your Payment Voucher
 What to do next

Visit https://www.pup.edu.ph/iapply/procedure/ousee
for more information.

PUP will not be held responsible for the loss of these documents that will arise from the applicant’s negligence.

NO VALID DOCUMENTS, NO PROCESSING.

 POLYTECHNIC UNIVERSITY OF THE PHILIPPINES
OPEN UNIVERSITY SYSTEM
4/F NALLRC BUILDING, A. MABINI CAMPUS
STA. MESA, MANILA Attach 2” x 2” Photo

PUP OUSEE APPLICATION FORM Same photo used in online

FOR THE SECOND SEMESTER, ACADEMIC YEAR 2022-2023 registration

PERSONAL INFORMATION:Reference No. 2023-0063-0295

Complete Name: ROILAN CAGALPIN FRANCIA

Sex: MALE Birth Date: 3/18/1998

Civil Status: SINGLE Disability: NOT APPLICABLE

CONTACT INFORMATION:

Email Address: roilanransin18@gmail.com Contact No/s.:09953262061,

Address: PUROK 4, BRGY 7, GENERAL LUNA, QUEZON, BRGY. BARANGAY 7 (POB.), GENERAL LUNA, PHILIPPINES (THE)

IN CASE OF EMERGENCY, Please Notify:

Contact Person:CEDIE MAE A. MANINGAS Contact No/s.:09109743962

Address: BRGY 5, ALABAT, QUEZON, BRGY. BARANGAY 5 (POB.), ALABAT, PHILIPPINES (THE)

ACADEMIC INFORMATION (LAST SCHOOL ATTENDED):

Degree Title & Major:EDUCATION UNIT EARNER

School Name: QUEZONIAN EDUCATIONAL COLLEGE, INC.

School Address:633 DR RAMON SOLER ST, ATIMONAN, 4331 QUEZON Year Graduated:2022
EMPLOYMENT INFORMATION:

Job Title:
Employer: Contact No/s.:

Employer Address:
ACADEMIC PROGRAM PREFERENCE:

Program/Course: MPAOUMN-MASTER OF PUBLIC ADMINISTRATION (OU-MANILA)

DOCUMENTS PRESENTED AND/OR SUBMITTED:

Letter of Intent addressed to the PUP OUS Executive Director,
 Dr. Carmencita L. Castolo  Filled-up Recommendation letter form (Download the form)

 Transcript of Records from the last school attended  PSA Birth Certificate
PSA Marriage certificate (for female applicants who opt to use
 her husband surname)  Certificate of Employment

 NBI/Police Clearance (for unemployed applicants)  PUP iApply payment voucher

Proof of payment (duly validated LBP Cash Deposit Slip or PUP Two copies ID pictures, 2 x 2 inch (recent, identical, in formal attire, white
 Cashier Official Receipt)  background)
These documents contain personal-identifiable information that is subject to Data Privacy. Please keep these documents protected and in a safe place.
Transact and submit only to an Authorized PUP Admission Officer.

APPLICANT’S SIGNATURE OVER PRINTED NAME DATE