UNIVERSITY OF THE PHILIPPINES LOS BAÑOS

Office of the University Registrar

APPLICATION FOR OFFICIAL TRANSCRIPT OF RECORDS AND CERTIFICATIONS
Note: Official Transcript of Records (OTR) and certifications are released only upon submission of a duly approved University clearance. If
the applicant is not the party concerned, a SIGNED authorization letter and photocopy of valid ID from the latter, along with a valid ID of the
authorized representative are required before the request for documents can be accommodated.

Processing Time Fee

OTR First Issuance 4 weeks after request is filed P50.00 per page
Peak Period (July-September) 5-6 weeks
Recopy 1-2 weeks

Certifications 5 days P50.00/copy

Certified True Copy of OTR 5 days P40.00/page
Certified True Copy of Diploma 5 days P40.00/copy
Diploma Translation 5 days P50.00/copy
*Unclaimed OTRs/certifications are shredded one (1) year after request is made

Date of Application: ________________________

Please tick appropriate spaces for document/s being requested and indicate number of copies requested:
OTR first request recopy
Certification DFA Requirement
Certificate of Graduation Certified True Copy of OTR
English as Medium of Instruction Certified True Copy of Diploma
Certified True Copy of Diploma English translation of diploma
Certified True Copy of OTR SO Certificate
English translation of the Diploma CAV Certificate
Purpose of Application:
For Board/Licensure Examinations For Employment
Please send a scanned copy of passport
size picture in JPG format
For Further Studies
Others ________________________

For OTR/documents to be placed in a sealed envelope.

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Contact No. _______________________
PERSONAL INFORMATION (please PRINT legibly)
_______________________ ____________________________ _______________________
Last Name Given Name Middle Name
Sex _____ Student Number ____________
Permanent Address ______________________________________________________________________________
Tel. Number ____________ Cell phone Number ______________ E-mail address _______________________
Date of Birth ______________ Place of Birth __________________
Father’s Name _____________________________ Mother’s Maiden Name _____________________________
ACADEMIC INFORMATION
Semester/Year Admitted ____________________
Admitted as New Freshman Transferee Non-degree Second degree
MS PhD
Last Semester/Summer Enrolled at UPLB __________________________
Degree(s)/Title(s) earned at UPLB ____________________________ Major/Specialization ______________________
Classification Transferred Graduated Currently enrolled Graduating
Schools Attended Name Location Course Date of Graduation
High School __________________________________________________________________________________
College __________________________________________________________________________________
Master’s __________________________________________________________________________________
PhD __________________________________________________________________________________
Cross-registered in other UP units? Yes No
If yes, indicate UP campus _____________ Semester attended______________ Subject(s) taken _______________