Western Colleges, Inc. Rev.

2/20/2020 norie
Naic, Cavite
CLAIM STUB Tel. No. 507-0500 (109) / Cellphone No. 0965-391-6843
Page: Western Colleges Records Management
APPLICATION FORM

( ) Form 137 (P170.00/page) (P120 with Request)
( ) TOR (270/page; P470.00/2pages)
___________ for use abroad
___________ for school with request
___________ for evaluation
___________ for employment
___________ for promotion
( ) Diploma (2nd copy P220.00)
( ) Certificate of___________ (P 120.00)
( ) Certificate of Transfer Credential
(270/page TOR; P470.00/2pages TOR)
( ) CAV MAED Requirement (P550.00)
( ) Others _____________________

√NAME (Print) ________________________ Dept. H.S. ________ College_______

√School Year Attended__________________ Release Date ____________________
High School Signatories College Signatories
Librarian ________________________ Librarian ___________________
Accountant ______________________ Accountant _________________
Principal ________________________ Dean ______________________
Registrar ________________________ Registrar ___________________
NOTE: Records are released after the date of application, if NOT claimed within one month, the requested
documents will be disregarded and another request should be applied.
P.S. Authorized representatives must present a letter of authorization and I.D. from the owner to be able
to secure any record.
…………………………………………………………………………………………………………….
√Name ________________________________ Dean ____________ Librarian ____________
√School Year Attended ___________________ T.O.R. (H.S.) _________ (College) ____________
Release Date __________________________ Diploma (H.S.) ________ (College) ____________
√Contact No./Tel. No. ____________________ C.T.C. ______ Cert. _________ Others _________
Remarks ____________________________________________________________________________ kaa

Western Colleges, Inc. Rev.2/20/2020 norie

CLAIM STUB Naic, Cavite
Tel. No. 507-0500 (109) / Cellphone No. 0965-391-6843
Page: Western Colleges Records Management
APPLICATION FORM
( ) Form 137 (P170.00/page) (P120 with Request) ( ) Diploma (2nd copy P220.00)
( ) TOR (270/page; P470.00/2pages) ( ) Certificate of___________ (P 120.00)
___________ for use abroad ( ) Certificate of Transfer Credential
___________ for school with request (270/page TOR; P470.00/2pages TOR)
___________ for evaluation ( ) CAV MAED Requirement (P550.00)
___________ for employment ( ) Others _____________________
___________ for promotion

√NAME (Print) ________________________ Dept. H.S. ________ College_______

√School Year Attended__________________ Release Date ____________________
High School Signatories College Signatories
Librarian ________________________ Librarian ___________________
Accountant ______________________ Accountant _________________
Principal ________________________ Dean ______________________
Registrar ________________________ Registrar ___________________
NOTE: Records are released after the date of application, if NOT claimed within one month, the requested
documents will be disregarded and another request should be applied.
P.S. Authorized representatives must present a letter of authorization and I.D. from the owner to be able
to secure any record.
…………………………………………………………………………………………………………….
√Name ________________________________ Dean ____________ Librarian ____________
√School Year Attended ___________________ T.O.R. (H.S.) _________ (College) ____________
Release Date __________________________ Diploma (H.S.) ________ (College) ____________
√Contact No./Tel. No. ____________________ C.T.C. ______ Cert. _________ Others _________
Remarks ____________________________________________________________________________ kaa