Rizal, Philippines

OFFICIAL REGISTRATION AND ASSESSMENT FORM

Campus : Rizal Academic Term : Second TrimesterAcademic Year : 2022-2023

Student Number : 20191456 LRN : Year/Status : 3rd-REGULAR
Full Name : AMIRA FATIMA CRUZ CANA Sex : Female
Course : BSC Major : Contact # : 9051603869
Home Address : 139 A1 M.C GUINTO MALASAGA ST. PINAGBUHATAN PASIG CITY

Subject/s Section Lab Units Lec Units Days Time and Date Room
OLFIL-03 LFCA221N084 0 3 MWF 11:00 am - 12:00 pm
OLCPCLJ3 LFCA322A051 0 3 MWF 04:00 pm - 05:00 pm
(3anqcnv)
OLCPCRIM6 LFCA321A091 0 3 TTHS 03:00 pm - 04:00 pm
(ynxwtl2)
OLLITEOO2 LFCA223A089 0 3 TTHS 04:00 pm - 05:00 pm
(xhktm7e)

Tuition Fee Laboratory Fee Miscellaneous Fee Special Subject Total Amount

1,560.00 0.00 2,270.00 0.00 3,830.00

Other Fees 100.00

LMS Fee 300.00
Student Portal Fee 300.00
Drug Test 200.00
Mailing Fee 60.00
Health Diagnostics 250.00
Test Booklet 30.00

Fullpayment FULLPAYMENT X Installment X Regular Fees TOTAL Php 5,070.00

with Discount
10% Cash Discount if FULL PAYMENT Php 4,687.00 made on or before Jan 11, 2023
EXAMINATION PERMIT Installment Payment Schedule
CONTROL NUMBER Amount Due Dates Late Payments Penalties
Full Paid (Cash Basis) Down Payment 1,280.00 Jan 12, 2023 5% Jan 13 onwards
000000 1st Installment 955.10 Feb 01, 2023 5% Feb 02 onwards
2nd Installment 955.10 Feb 16, 2023 5% Feb 17 onwards
Installment Basis 3rd Installment 955.10 Mar 01, 2023 5% Mar 02 onwards
Prelim - 4th Installment 955.10 Mar 16, 2023 5% Mar 17 onwards
Midterm - 5th Installment 424.50 Apr 01, 2023 5% Apr 02 onwards
Final - TOTAL 5,524.90

REMARKS:
This form must be presented and acknowledged by the Instructor / Professor during your first day of
class attendance; by signing at the back of the Accounting's Copy hereby affirmed your acceptance
of the School Rules and Regulations. Control No.: 00000000