For everyone's reference regarding applying for UNiversity clearance and the graduation rites.

1. 2012 GENERAL COMMENCEMENT EXERCISES
WHEN : 22 April 2012
WHERE : University Ampitheatre (behind Quezon Hall)
ASSEMBLY TIME : 2:00 PM
START OF PROGRAM : 3:00 PM
REMINDER: Please advise your guests attending the graduation rites to observe university rules to keep the graduation rites
solemn and orderly. All attendees are expected to stay for the duration of the entire graduation rites, and dress and behave in a
manner in keeping with the solemnity of the occasion.
TO: ALL 2012 GRADUATES
CONGRATULATIONS!
We are glad to inform you that April 2012 graduates can now avail themselves of the expedited
processing of their application for a University Clearance, a copy of their Official Transcript of Records
(OTR), and a Certificate of Graduation (COG). You may start applying on 16 April 2012.
Please fill out the attached UP Form 241 (Clearance) and OTR application forms and pay the
following fees at the Cashier’s Office (2nd floor, ISSI Building):
(Check what you have already accomplished)
Graduation Fee
Pay the graduation fee of Php 300.00 (inclusive of the diploma fee) at the Cashier’s Office
nd
(2 floor, ISSI Building). The official receipt will be required when claiming the diploma.
After paying your graduation fee, present the official receipt to your College Secretary and
Php 300.00
get the following:
• 2 seat tickets for the General Commencement Exercises
• 1 auto pass
Clearance Fee
Processing of transcripts may take longer than usual because of the volume of requests 30.00
during the months of May to July.
1 set of OTR
One set of a 2-page OTR only. If applicable, you will be charged an additional fee for an OTR 100.00
exceeding two (2) pages. Additional copies will be charged additional fees.
1 copy of COG 30.00
Sablay
The Sablay is available in Hablon, handwoven in Iloilo, costing Php 750.00 (small and
medium) and Php 800.00 (large). You may place your order for the sablay at the Benitez
Alumni Hostel, Magsaysay Avenue cor. Ylanan Street (in front of DMST/UP Vanguard). For 750.00
inquiries, please contact 981-8500 ext. 4258 or 929-3386 and look for Ms. Norma Castro.
or
You may also pay for this directly at the Cashier’s Office under the account name, “Sablay
Management.” 800.00
On the day of graduation, please make sure your academic costume is complete; the Sablay
should be on your right shoulder.
Total amount you have to prepare for all items TOTAL Php 1,210.00/
1,310.00
HOW TO APPLY FOR CLEARANCE AND OTR
1. Present application for OTR and the Official Receipt (O.R.) at the counter of the Transcript of
Records (TOR) Section, 2nd floor, OUR Building, for assessment and issuance of OTR stub.
2. Submit the forms (applications for OTR and Clearance) and present the O.R. at the One-Stop-
Clearance-Center (OSCC) Window 5, 1st floor, OUR Building, starting 16 April 2012. You will be
issued a clearance claim stub. The OSCC will accept and process 100 applications per day.
3. You may follow up the status of your applications based on the claim date provided on the claim
stubs of the TOR Section and OSCC.
NOTE: The above procedure is applicable to all graduates except from the College of Law since a
member of the Bar Operations Secretarial Commission Committee takes charge of processing
their clearance and OTR applications.

2. OFFICE OF THE UNIVERSITY REGISTRAR CLAIM STUB NO.:
University of the Philippines Diliman DUE DATE:
Quezon City
(TOR Trust Fund A Code No. 9774700)
Note: Please PRINT your name
and address. Thank you.
1X1
or
2X2 Required only for bar/board applicants
picture
TO: CASHIER
Total
Graduation fee P 300.00 (0509.10.003.1460.60-515-615)
Clearance fee P 30.00 TOR Trust Fund B (9774711)
One set OTR * P 100.00
A copy of COG P 30.00 TOR Trust Fund A (9774700)
P 460.00
Additonal:
OTR copies x 100
COG copies x 30
TOTAL
* OTR consists of 2 pages only
DATE:
AMT PAID
Optional: O.R. NO.
PURPOSE OF APPLICATION (Pls. check):
Employment Local Abroad PRC Licensure Exam P-MED
Scholarship Local Abroad BAR Exam LAE
Enrollment Local Abroad Transfer to other School
Migration Records Purposes COPY FOR (Notation)
UPDilman / UP System Others
NAME OF STUDENT
(Please Print Legibly) LAST FIRST MIDDLE MAIDEN
(Based on birth certificate; If married, encircle family name used during last enrollment in U.P.)
PERMANENT ADDRESS:
STUDENT NO.: Father's Name:
Mother's Maiden Name:
DATE & PLACE OF BIRTH
OF STUDENT
PLEASE CHECK:
To be picked up personally (unclaimed TORs/COGs within 6 months are shredded)
To be mailed to the following address (es)
(If more than one, attach mailing list)
CONTACT NO:
To be placed in official envelope(s) Yes No
COLLEGE(S)/UNIT(S)* DEGREE/MAJOR INCLUSIVE DATES DATE OF GRADUATION
ATTENDED IN U.P.
NOTE: NON-DISCLOSURE of complete enrollment in UP will cause delay in processing your TOR since an UPDATED CLEARANCE IS NEEDED.
*If shiftee, please indicate college last attended.
sadf U.P. CAMPUS(ES) WHERE YOU CROSS REGISTERED (If any) INCLUSIVE DATES
For students who transferred or obtained their first degree from another school, please indicate all schools attended
in chronological order:
Name & Location of Institution Inclusive Dates Degree/Title Obtained
Signature of Student: Tel./Mobile No: E-mail add:
If representative is filing the application for the student, please furnish the following information:
Name of Representative: Signature: E-mail add:
Complete Address: Tel./Mobile No:
NOTE: 1) If to be claimed by a REPRESENTATIVE, present a letter of authorization, claim stub and your valid I.D. upon claiming the
requested documents.
REV. jc 03262012

3. FOR UNIVERSITY CLEARANCE APPLICATION ONLY
UP Form 241 (Revised Mar 2012) (To be filled up by OSCC personnel)
PENDING ACCOUNT WITH _______________________________
OFFICE OF THE UNIVERSITY REGISTRAR
UNIVERSITY OF THE PHILIPPINES - DILIMAN DATE RECEIVED _________BY________
One-Stop Student Clearance Center (OSCC)
TRANSCRIPT FUND B
CODE # 9774711 – Records Section
IMPORTANT: 1. PLEASE PROVIDE ACCURATE & COMPLETE DATA TO AVOID DELAY CERTIFICATION:
IN PROCESSING. CLEARANCE - P 30.00
2. KEEP YOUR CLEARANCE CARD WHICH YOU WILL PRESENT EACH
O. R. No. : _____________________
TIME YOU TRANSACT BUSINESS REQUIRING CLEARANCE
AMT. PAID : ____________________
(e.g. APPLICATION FOR TRANSCRIPT OF RECORDS, DIPLOMA,
HONORABLE DISMISSAL and CERTIFICATE OF GRADUATION).
DATE : _________________________
STUDENT NO. - PURPOSE: ____________________________________
NAME ___________________________________________________________ SIGNATURE _________________
FAMILY FIRST MIDDLE MAIDEN
(If married woman, encircle family name used during last enrollment in UP)
FIRST ENROLLMENT IN U.P. ________________________________________________________
SEMESTER ACADEMIC YEAR COLLEGE
LAST ENROLLMENT IN U.P. ________________________________________________________
SEMESTER ACADEMIC YEAR COLLEGE
YEAR GRADUATED ___________________ DEGREE ________________________________
PRESENT ADDRESS __________________________________________________ First Time to Apply Yes No
CONTACT NO. (Landline/Mobile phone)______________________________ E-MAIL : _____________________________
COLLEGE STUDENT DISCIPLINARY TRIBUNAL (SDT)
CLEARED BY _____________ DATE _________ CLEARED BY _____________ DATE _________
UNIVERSITY LIBRARY / COLLEGE LIBRARY U.P. HEALTH SERVICE
CLEARED BY _____________ DATE _________ CLEARED BY _____________ DATE _________
UP STUDENT HOUSING (DORMITORY) STUDENT LOAN BOARD
CLEARED BY _____________ DATE _________ CLEARED BY _____________ DATE _________
OFFICE OF THE UNIVERSITY REGISTRAR
Graduation Fee P ______________ OR # ________________ Date __________________
UNDERASSESSMENT
Nature Semester Amount OR# Date
__________________________ __________________ ____________________ ___________________ ___________________
__________________________ __________________ ____________________ ___________________ ___________________
__________________________ __________________ ____________________ ___________________ ___________________
__________________________ __________________ ____________________ ___________________ ___________________
CLEARED (Underassessment) CLEARED (Scholarship)
BY _____________ DATE _________ BY _____________ DATE _________
ENTRANCE CREDENTIALS SUBMITTED
Official Transcript of Records _______________
High School Card _________________________
F 137 __________________________________
______________________________________
GRADUATED IN U.P. YES NO DEGREE & DATE _________________________
CLEARED BY
AMELITA S. JORDA DATE _________________
CHIEF
ADMISSION and REGISTRATION SECTION AS OF _________________