UNIVERSITY of the ASSUMPTION

OFFICE OF THE UNIVERSITY REGISTRAR

REQUEST FORM FOR DOCUMENTS Form R-01A Feb 2016 Revision
Date Requested √ Date Due
PERSONAL INFORMATION ACADEMIC INFORMATION
Last Name √ ID No √
First Name √ Program/Degree √
Middle Name √ Did you graduate from UA?
Gender √ Yes I graduated from UA No, my last enrollment was on
Birthday √ on ___________________ ________ sem _________ SY
Did you have a change No Granted Transfer Credentials? Yes No
or correction of name at UA? Yes, my original name was (please CLAIMING INSTRUCTIONS
specify)_ __________________________ PICK UP. The document/s will be claimed by the owner who will present
CONTACT INFORMATION one (1) valid ID upon claiming and the Official Receipt.
Tel. No.(Home) √ PROXY. A proxy/representative will claim the document/s.Upon claiming,
Cell No. √ he/she will present an authorization letter from the owner, his/her valid ID,
Email Address √ valid ID of the owner and the Official Receipt.
Address (with zip code) √ Name of Representative √
Signature of Representative √
Cell No. √
SIGNATURE OF OWNER √ Email √
Please indicate check mark in the appropriate box. to be filled out by the Records in-charge
DOCUMENT PURPOSE OF REQUEST FOR DOCUMENT QUANTITY PRICE
2nd Issuance of Diploma For Verification Purposes Visa Application
661.00 Php (20 working days) For Record Purposes Others _________________
Transcript of Records For Board Exam Purposes Verification
200.00 Php (5 working days except For Employment Purposes Record Purposes
during graduation and enrolment season) For Evaluation Purposes Others _________________
DOCUMENT TYPE PURPOSE OF REQUEST
Certification Enrollment/Attendance Verification
50.00 Php Units Earned/Grades Record Purposes
(1 working day) Completion of Academic Requirements Board Examination
Graduation, Special Order /with honors Employment
Candidacy for Graduation Evaluation
Cumulative GPA/Rank in Batch Visa Application
President's/Dean's List Scholarship
English as Medium of Instruction Others _________________
Course Description
English Proficiency
Others ______________________
Transfer Credentials True Copy of Grades and Evaluation
300.00 Php (5 working days) Certificate of Eligibility to Transfer
Authenticated Documents - Diploma Registration Form Verification
Certified True Copy of Documents Certificate Evaluation Form Record Purposes
photocopied documents with RLE Others ________ Board Exam
the signature of the Registrar Form 137 Employment
and the dry seal of UA) Form 138 Evaluation
50.00 Php / 5 copies/document Transcript of Records Visa Application
Identification Card Others _________________
(1 working day) Consolidated Copy of Grades
Other Documents Consolidated Copy of Grades Scholarship
100.00 Php (1 day - Consolidated Copy Evaluation Form Replacement Purposes
of Grades, 3 days - Evaluation form) Others _____________________ Others _________________ TOTAL
PROCEDURE FOR SECURING DOCUMENTS 3. Secure the Signature of the Director for Libraries(for 1st time applicants only).
1. Have fees assessed by the Records-in-charge. _________________________ ________________
________________________ __________________ Director for Libraries Date
Records in-charge Date 4. Settle the document fee at the Finance/Treasury Office (Cashier).
2. Secure the Signature of the Dean (for 1st time applicants only). __________________________ ________________
_______________________ __________________ University Treasurer Date
Dean Date 5. Submit the approved form and present the Official Receipt at the OUR.
Only first (1st) time applicants need to be cleared at the Dean's Office and __________________________ ________________
at the College Library. Second (2nd) time applicants may skip steps 2 and 3. Records in-charge Date

UNIVERSITY of the ASSUMPTION Form R- 01A

CLAIM STUB OFFICE OF THE UNIVERSITY REGISTRAR
Tel. No. (045) 961-1648, email address: [email protected]
STUDENT'S COPY
Student Name √ Date Requested √
Program/Degree √ Date Due √
Year Level/Year Graduated √ Registrar's Personnel
RECORD REQUESTED: 2nd Copy of Diploma Certification Authenticated Documents
Transcript of Records Transfer Credentials Others _______________________
NOTE: 1. Present the claim stub with the Official Receipt when claiming the requested document/s.
2. Representatives must present an Authorization letter signed by the owner of the document/s, ID Cards (of the owner and of the representative.
3. Document/s not claimed after 90 days from due date will be DESTROYED and payments made will be FORFEITED.
4. Pay only at the Finance Office: Monday-Friday (7:30am- 12:00nn, 1:00pm-6:00pm), Saturday (8:00 am -12:00 nn)
Form R-01A Feb 2016 Revision