Republic of the Philippines

Form 8 President Ramon Magsaysay State University

(Formerly Ramon Magsaysay Technological University)
Office of the Registrar – _______________ Campus

DOCUMENT REQUEST FORM

Fill out this form completely and accurately. PLEASE PRINT ALL ENTRIES
CLIENT’S INFORMATION (Record’s Owner)

First Name Middle Name Last Name Extension Name

(if there is any)
Male Female
Sex Birthday [Month Day, Year) Birthplace (Town/Municipality/City, Province, ZIP Code)
Did you have a change or correction of name at PRMSU?
No Yes, my original name was: __________________________________________________________________
ACADEMIC INFORMATION
Student number: Latest Program/Degree at PRMSU:
Did you graduate from PRMSU?
Yes, I graduated on (pls. specify complete date of graduation for latest program/degree) _______________________________
No, I did not graduate from PRMSU. My last term of attendance was  1st term  2nd term  3rd term  Summer/Midyear
of School Year __________ - __________
[CONTACT INFORMATION] Tel./mobile number: Email address:
Home/Mailing address:
DETAILS OF DOCUMENT REQUEST
Purpose of
Date Requested
request:
Please identify the type/s of document/s being requested & include the number of copies to be requested for each type of document
# of # of # of
Document Type Copies Document Type Copies Document Type Copies

 Transcript of Records  Original Diploma xxxxx  Certified True Copy of

(list document/s below)

 For PRC/Board Exam  Copy of Diploma

 For Employment  Form 137
 For Evaluation/Reference  Related Learning
 For OJT/Practicum Abroad Experience (RLE)

 Copy For
 CERTIFICATIONS
# of # of # of
Certification Type Copies
Certification Type Copies
Certification Type Copies

 Enrollment / Registration  Graduation  Candidate for Graduation

 As Honor Graduate  Grades  Grades (all terms attended)

 GWA  Subjects Enrolled

 English as Medium of
Instruction

 Units Earned  Course Description (max of 5)  Certification, Authentication,

Verification (CAV)

 Academic Completion  Transfer Credentials

For submission by client
Request received by (name and signature of receiving staff):
Date of issuance of requested document/s
Code: PRMSU-ASA-OURSF 8 Revision No.: 05 Effectivity Date: March 1, 2023

DOCUMENT REQUEST CLAIM STUB (PRMSU – Office of the University Admission and Registration Services)
Client’s name: Date of request:

Document/s Requested: Date of issuance:

For submission by client:

Request received by: Signature

Code: PRMSU-ASA-OURSF 8 Revision No.: 05 Effectivity Date: March 1, 2023

CLAIMS / DELIVERY INSTRUCTIONS. Please select and mark your preferred mode of issuance/release of the requested document/s.

PICK UP. The document/s will be claimed by the owner who, upon claiming, will present one (1) valid ID and the Official Receipt of pay ment.

PROXY. A proxy/representative will be sent to claim the document/s. Upon claiming, he/she will bring the authorization letter from the record’s owner, a photocopy of his/her valid ID
(original ID to be presented to the processing staff), and one (1) photocopy of the valid ID of the owner and the Official Receipt of payment.
Name of Authorized Representative:
_____________________________________
Contact number of representative:
_____________________________________
COURIER. Please send the document/s via courier to the address indicated in the form. It is understood that the delivery period is over and above the processing period. (Please read the
following policies adopted by the University for the delivery of requested document/s via courier services)
Complete Mailing Address: _______________________________________________________ Preferred courier service (if any):
______________
1. Courier services for requested documents from President Ramon Magsaysay State University will be through LBC (unless otherwise specified by the client, and availability of preferred
courier services in the area).
2. The Office will only be shipping documents domestically. Documents requested to be sent to recipients outside of the country will be coursed through the owner of the record
requested (or through their authorized representative). The Office will surrender requested documents to the owner of the record (or their authorized representative), and the latter
will facilitate the shipping of the document to its intended recipient.
3. Delivery charges for courier service shall be charged to the client, payment of which must be made before processing of the request. The standard delivery rate of courier service
will be applied.
4. Payment, covering the cost of the document, convenience fee, and delivery/shipping fee, will be made by the client through the Collecting Office or via LBP online payment process
adopted by the University.

Payment includes fees for the following:

Processing Fee Courier Convenience
Service Fee Fee

Initial payment for TOR, amounting to Php 150.00 will be paid by the client before the requested document is processed by the Office. The standard Php 50.00
delivery rate
Payment for additional pages on the requested TOR will be made by the client before pick-up at the Office or Delivery to the intended of courier
recipient (additional Php 100.00 for each succeeding page/s). service will be
applied.
Payment will be coursed through University-approved payment collection channels

5. The period for payment posting and processing may vary depending on the channel used by the client and is excluded from the allotted processing time as per the policy of the Office.
Presentation of an Official Receipt will serve as proof of payment.
6. Delivery/shipping time may take 1 to 3 days (or more) depending on courier service.

Delivery shipping time is excluded from the allotted processing time as per the policy of the Office.
Processing time is the number of working days allotted in the preparation of the requested document starting from when the request was acknowledged by the Office up to the day
when the requested document is made available for either pick-up by or delivery to the client.
Acknowledgment of Request by the Office is when the client has satisfied all the requirements for his/her request thus prompting the Office to act on it. This is accompanied by the
issuance to the client of an accomplished Acknowledgment Receipt Form.

CONDITIONS & REMINDERS

1. Under existing laws, only the owner of the records is allowed to request documents in connection with his/her school records and claim the requested documents.
2. The University reserves the right to withhold, deny or cancel any request for document/s due to incomplete requirements and/o r pending accountabilities of the student.
3. To verify the identity of the requesting/claiming party, one (1) valid identification card shall be required for presentation upon request and one (1) valid identification card upon claiming the
document/s.
4. Requests and claiming of documents by representative/proxy should be covered by an accomplished Proxy Request of Records Form or an Authorization Letter from the record’s owner. The
proxy/representative must present his/her valid ID and one valid ID of the owner during said transactions.
5. Please return this form to the Office of the University or Campus Registrar after payment at the Accounting Office (if payment is applicable). Without this form, the request cannot be processed.
6. Documents not claimed after two (2) years will be destroyed.

CONFORME. I have read and understood all the conditions and reminders in connection with this request. I likewise agree to comply with them. I hereby certify the
correctness of all entries. Any false information I supplied shall render me liable for the consequences of my wrong actions.

__________________________________________ _________________
Signature over Printed Name of Client Date

DATA SUBJECT CONSENT. This is to certify, that I, _____________________________________________________, have given my permission to the
(Complete name of client)
PRMSU – Office of the University & Campus Registrars’ Offices in the collection, lawful use and disclosure of my personal information (including sensitive and privileged
information, if may be applicable), which may or may not include all information contained in the forms and documentations I have submitted in line with the preparation and
issuance of my requested document/s.
This is also to certify that I have permitted the PRMSU – Office of the Campus & Registrars’ Offices and other appropriate offices in the University to provide the above-
cited information to legitimate offices/institutions requesting such information in relation to the performance of their legitimate/lawfully-mandated functions.
This further permits the PRMSU – Office of the Campus & Registrars’ Offices to process my information to the maximum extent allowed by law, to pursue its objectives as
an educational institution. This may include a variety of academic, administrative, research, historical, and statistical pur poses.
I am assured that the security systems of the PRMSU – Office of the Campus & Registrars’ Offices are in place to protect and safeguard my personal information.
I understand that the PRMSU – Office of the Campus & Registrars’ Offices are authorized to process my personal and sensitive personal information without the need for
my consent under the relevant portions of Sections 4 (Scope), 12 (Criteria for Lawful Processing of Information) and 13 (Sensitive Personal Information & Privileged Information)
of the Philippine Data Privacy Act.
This consent allows the PRMSU – Office of the Campus & Registrars’ Offices to comply with R.A. 10173, also known as the Data Privacy Act of 2012.

Signed this ______ day of ______________, __________, at President Ramon Magsaysay State University, Iba, Zambales.

_______________________________________________________
Signature over Printed Name of Client

Code: PRMSU-ASA-OURSF 8 Revision No.: 05 Effectivity Date: March 1, 2023

OFFICE OF THE UNIVERSITY ADMISSION Office of the Campus Registrar

AND REGISTRATION SERVICES Campus: _________________________________________
Facebook Page: Student Admission and Registration Services - PRMSU Contact number: _________________________________________
Email: [email protected]
|| Website: www.prmsu.edu.ph Email Address _________________________________________
Tel/Fax No.: (047) 602-6120-24 local 129

Code: PRMSU-ASA-OURSF 8 Revision No.: 05 Effectivity Date: March 1, 2023