Republic of the Philippines UNIVERSITY OF ANTIQUE Sibalom, Antique REGISTRATION FORM. iat alla liste chau ae aman ae School Year: Term: ECOND SEMESTER Enrolment Status: Gg nae, ee 3 3 3 ‘StudiD: 2020-0175-A Name: VIRAYO, VINA | Som: SECOND SEMESTER SY: 2020.2021 Applied Amount ‘runt Pad Posod By | Fund Account Awount —rund_—_nocount. Datepaid oR Ho Anount os pevE. TEE-CTE 350.00 0.00 0s «GUIDANCE E 50.00 os LYBRanr ree 300.00 3 MEDICRL/DeWEAL WEE 220700 § | cs ararsrmarton 30.00 ol] ts ° mens 218100 3 os Seonzs DEVE. FEE 278.00 < 0748.00 ‘Balance for the SECOND SEMESTER SY 2020-2021 as of 2/4/2021 ls: Php. 5° ENROLLED L. \ Sst ‘Student’s Pledge and Consent ‘Asa student of the University of Antique this term, | hereby promise to ablde by the rules and regulations of the University now in force as ‘wall as those that may be promulgated during the time ! am stil enrolled. If | violate any of these rules, | shall bind |myself to whatever disciplinary action the University may Impose upon mé Furthermore, | hereby give my consent and authorize the University to use my personal data and other school records in the pursult of Its legitimate interest as an educational institution such as but not limited to compliance of reportorial requirements to the affilated organizations as part of its contractual obligations, or with government agencles and other regulatory bodies pursuant to the law or legal processes. Date: Signature: Contact Nox AnorMC28 ev 01/06 08-2020