Republic of the Philippines

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES

OFFICE OF THE VICE PRESIDENT FOR STUDENT AFFAIRS AND SERVICES PROCEDURE/STEPS
OFFICE OF THE STUDENT SERVICES Read carefully and understand the content of this Form. Be sure that this Form
is properly accomplished and signed by your parent/guardian accompanied with
APPLICATION FOR DUPLICATE OF LOST REGISTRATION CERTIFICATE their ID or Cedula (for undergrad students only) and by your Dean/Chairperson of
the College/Department before proceeding to the Guidance, Counseling and Testing
I. Statement of Lost / Promissory Letter
I, Mr./Ms. _____________________________________, a ________ year student, Center.
Bachelor of/in _______________________________________________________ from
the College of _________________________________________ with student number Step 1 INTERVIEW AND EVALUATION OF REQUIREMENTS
__________________ do hereby depose and say: Guidance, Counseling and Testing Center
Room 205, Charlie Del Rosario Student Development Center
That sometime on ________ I lost my Registration Certificate due to
______________________________________________________________________; * Photocopy this form before proceeding to the University Legal Office
that earnest and diligent effort to locate the same was rendered futile; and that the
Step 2 ENDORSEMENT OF REQUEST
same was not confiscated by authorities for violation of any law or used for illegal
University Legal Counsel Office
purposes. Room S302, Main Academic Bldg.
In view thereof, I am requesting that a duplicate copy of my Registration
Certificate be issued in my favor. I undertake to be more careful and prudent next time Step 3 PAYMENT
so that this incident will not be repeated. I am willing to submit myself to a Cashier’s Office
corresponding disciplinary action should I lose the said document again. Ground floor South Wing
CERTIFICATE FEE: P 150.00
Signature over printed name Step 4 APPROVAL OF REQUEST
Signature of parent/guardian Office of the Student Services
Room 208, Charlie Del Rosario Student Development Center
Attested by:
Step 5 ISSUANCE OF DUPLICATE COPY OF REGISTRATION
_________________________________ CERTIFICATE
Dean/Chairperson
II. Action Taken Please proceed to the office concerned for the issuance of your request
We have already interviewed the above named student who lost the For 1st year (Undergrad) Admission Services
abovementioned document. We also evaluated all requirements he/she had submitted Ground Floor West Wing
in this office and we found the same to be complete, in order, sufficient and nd Office of the University Registrar
For 2 year & above Ground Floor South Wing
satisfactory.
GS Registrar’s Office
Respectfully endorsed for approval. For Graduate School
GS Bldg., PUP M. H. Del Plar Campus
DR. NENITA F. BUAN
For Open University OUS Student Services
Director, Counseling and System
Psychological Services 4th Floor NALLRC Bldg.
PUPLHS Registrar’s Office
Recommending Approval: Approved by: For LHS
PUPLHS Bldg.
ITech Registrar’s Office
Institute of Technology
ATTY. JOANNA MARIE A. LIAO PROF. JOSE M. ABAT ITech Bldg., PUP NDC Campus
Chief, University Legal Counsel Office Director, Office of Student Services CL Registrar’s Office
College of Law
Lower Ground, NALLRC Bldg.
THIS FORM IS NOT FOR SALE