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Form

STUDENT ACTIVITIES AND LEADERSHIP DEVELOPMENT

A9 (2012)

Office of Student Affairs, Xavier University Ateneo de Cagayan


Rm 204, 2/F Magis Student Complex (Tel) 858-3116 local 3330

FEES COLLECTION REPORT


(Please accomplish 2 copies.)

Name of Organization:
School of Business and Managements Student Council
Name of Activity where collection of counterpart was done:
(Please type here.)
Purpose of the Collection:
(Please type here.)

(Please state the reason/ justification why collection was done.)

Duration of the Collection/ Date of Collection:


From (dd/mm/yy)
To (dd/mm/yy)
(Please type here.)
(Please type here.)
Summary of Cash Collection:
Number of Payers
Amount Paid
(Please type here.)

Total Amount Collected:


(Please type here.)

Series/ Control Number Assigned


to Issued Acknowledgment Receipt

Remarks (To be filled by SACDEV)

Php

AGREEMENT:
We understand that there are rules and regulations which govern collection of fees in the University. Failure to abide by
them entails sanctions for the organization and disciplinary measures for the students involved.

JUAN DE LA CRUZ
Signature Over Printed Name
of Project Head
0920XXXXXXX

Deoanalin May Castillo


Signature Over printed Name
of President

Leo Arrabaca III


Signature Over printed Name
of Moderator

Approved by:

MS. RICHEL P. PETALCURIN


Student Activities and Leadership
Development Head

IMPORTANT:
This form applies to collection of membership fee, registration fees for some activities (e.g. seminar), counterpart from members, service fee,
rental fee, or any fee collected by the organization.