TIP-REG-01

OFFICE OF THE REGISTRAR Revision Status / Date: 1 / 2018 February 12

Quezon City Manila

GRADUATION RITES CLEARANCE AND REQUEST

FOR DOCUMENTS FOR SENIOR HIGH SCHOOL
INSTRUCTIONS: REMINDERS: OFFICE OF THE REGISTRAR
Date of Graduation
1. Fill out the form properly and print clearly all information requested. 1. An authorization letter together with valid ID cards of both the requesting
2. Route the form to the different offices indicated. student and authorized representative must be presented, if the claimant is
3. Always present your T.I.P. student I.D. before making any transaction. not the person concerned.
4. Submit the accomplished form with the following requirements:
4.1. Two (2) 2" x 2" colored picture 2. Diploma / Certification not claimed within six (6) months from the date of
4.2. Two (2) Documentary Stamps. application shall be discarded or cancelled.

REQUEST FOR DOCUMENT

SURNAME: FIRST NAME: MIDDLE NAME:
ANTOLIN DIANNA MAE ENANO
STUDENT NO.: LEARNER REFERENCE NUMBER (LRN): EMAIL ADDRESS:
S1711071 136563060009 diannamaeantolin@yahoo.com
PERMANENT ADDRESS: CONTACT NO.:
# 9 MARYTOWN LOYOLA HEIGHTS QUEZON CITY 09154486794 / 09154486794
REQUEST: (Please check) PURPOSE: (Please check)

Diploma / Certificate Form 137 & Good Moral Certificate Application for College in T.I.P. Employment
Certification of Graduation Application for College in Other School
Others___________________ Others___________________

The TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES, acting upon my application for graduation in Senior High School this academic year
____________________________ has considered favorably offering me to complete/graduate, subject, however, to the School policies on
completion/graduation

The School reserves the right to cancel or revoke my graduation should my records submitted as requirements for graduation were later found to be
fraudulent.

Signature Over Printed Name of the Parent Signature of Student Date

STUDENT CLEARANCE
1 OFFICE OF THE REGISTRAR 7 STUDENT ACCOUNTING OFFICE
REMARKS:
Old account: Php_________________________
SIGNATURE: DATE:
Graduation Fee: _________________________
2 ADVISER Diploma: _________________________
SECTION: REMARKS:
Form 137 & Good Moral: _________________________
NAME & SIGNATURE OF ADVISER: DATE:
Certification: _________________________
3 ASSISTANT PRINCIPAL / PRINCIPAL
Documentary Stamps: _________________________
REMARKS:
Others_________________: _________________________
SIGNATURE: DATE:
TOTAL Php_________________________
4 OFFICE OF STUDENT AFFAIRS
REMARKS: VERIFIED BY: DATE:

SIGNATURE: DATE: AUDITED BY: DATE:

5 LIBRARY DEPARTMENT 8 TELLERING SECTION

REMARKS: AMOUNT PAID: O.R. NUMBER:

SIGNATURE: DATE: RECEIVED BY: DATE:

6 LABORATORY AND SHOPS DEPARTMENT 9 OFFICE OF THE REGISTRAR

REMARKS: DATE RECEIVED: DATE OF DOCUMENT(S) RELEASE:

SIGNATURE: DATE: SIGNATURE: DATE:

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TECHNOLOGICAL INSTITUTE OF THE PHILIPPINES CLAIM SLIP

Office of the Registrar QC (Telefax: +632-9121539) Manila (Telefax: +632-7364208)

NAME: REQUESTED DOCUMENTS: REMARKS (if any)

ANTOLIN, DIANNA MAE ENANO
STRAND: Diploma / Certificate
ABM (ACCOUNTANCY, BUSINESS AND MANAGEMENT) Certification of Graduation
Form 137 & Good Moral Certificate
DATE REQUESTED: DATE OF DOCUMENT(S) RELEASE: Others___________________

IMPORTANT: 1. An authorization letter together with valid ID cards of both the requesting student and authorized representative must be presented if the claimant is not the person concerned.
2. Diploma/Transfer Credentials not claimed with six (6) months from the date of application shall be discarded or cancelled.

Printed Date: 19-03-21 07:41:37