Online Request Form Rev 2

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Office of the University Registrar

REQUEST FOR ACADEMIC RECORDS


(Online Request Form)

STUDENT INFORMATION:

Last Name First Name Middle Name


Please PRINT your name based on your birth certificate; If married, print name used during last enrolment.

Contact Email address:


Number:
LATEST Program enrolled/completed at XU:
Year Level/Year Graduated: SLMIS ID (if applicable):

DOCUMENT: (please check (/) and specify quantity for each document)
Quantity of Authenticated
Document
Original Copies
Diploma (Reissuance of Diploma Requires an affidavit of loss)
Transfer Credential
Transcript of Records
Board
Bar
Reference
Employment
Visa
Authenticated copy of HS Report Card (F 138)
Authenticated copy of HS TOR (F 137-A)
Course Description (Please Specify the Subjects)

CERTIFICATES: (please check and specify quantity for each certificate)


Authenticated
Certificate Quantity
Copies
Graduation
Letter of No Objection
Special Order
English as Medium of Instruction
Enrollment: specify Sem & AY:
Nursing RLE (Request at Nursing, Release by REG)
WES Form
CAV
Local
Abroad (Apostille)
GWA / QPI (for students enrolled after 2013)
Others: Please Specify:

MODE OF RELEASING: (please check and specify required details)


For Scanning & email Email Address:
For Pick-up at Window 20 A/B Mon-Fri 8am-11am, 1pm-4pm
For Courier Delivery Address of Recipient (please specify full address):
(WExpress - local;
DHL - international) Telephone No. (required for international delivery):

REMARKS:

NOTE:
1. Download this form for your perusal.
2. After accomplishing this form, upload this to the online portal for assessment of fees.
3. Documentsnot claimed after six (6) months will be shredded and disposed accordingly..

Signature: Date:

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