REQUEST FOR DOCUMENTS (OUR F-09)	Date Applied	Click or tap to enter a date.	REQUEST RATES
Document/s Requested	No. of Copies	No. of Pages	Request Type	Amount
Transfer Credentials Non-Graduate P 150	CTC P 50/document
Please choose an item from the list.	copies	pages	Request type	Amount	Transfer Credentials Graduated College P 200	GWA P 50/copy
Please choose an item from the list.	copies	pages	Request type	Amount	Transfer Credentials Graduate School P 500	Course Description P 50/course
Please choose an item from the list.	copies	pages	Request type	Amount	TCG College P 100/page	Second Copy Diploma P 300/copy
Please choose an item from the list.	copies	pages	Request type	Amount	TCG Graduate School P 200/page	Grad School Cert P 150/copy
Please choose an item from the list.	copies	pages	Request type	Amount	Enrollment Certificate P 50/copy	CAV Endorsement P 200/copy
Please choose an item from the list.	copies	pages	Request type	Amount	Graduation Certificate P 50/copy	Transcript of Records P 100/page

PURPOSE OF REQUEST (please click on the drop-down arrow key and choose from the list of probable responses; tick the appropriate box)
Purpose of request	Please choose an item from the list.	Local	☐	Abroad	☐
PRC Licensure Examination	Enter details here	Medicine School	Enter details here
Law Aptitude Examination School	Enter details here	Transfer to	Enter details here
Copy for	Enter details here	Others	Enter details here

RELEASE DETAILS (please choose which mode do you prefer for the release of the requested document(s))
☐	For pick-up personally
☐	Please mail to this address	Enter details here
Contact No(s). of the recipient	Enter details here	Email Address	Enter details here

STUDENT INFORMATION (Based on birth certificate)
Enter details here	Enter details here	Enter details here	Enter details here
Student Number*	Surname*	First Name*	Middle Name, if any
Enter details here	Click or tap to enter a date.	Enter details here	Enter details here
Maiden Name, if married	Date of Birth	Place of Birth	Contact No(s)*
Enter details here	Enter details here	Enter details here	Enter details here
House No.	Street Name/Subdivision/Village	Barangay	City

ACADEMIC INFORMATION
Colleges Attended in PLMar	Degree / Major	Inclusive Date(s)	Date of Graduation
Enter details here	Enter details here	Enter details here	Click or tap to enter a date.
Enter details here	Enter details here	Enter details here	Click or tap to enter a date.
Admitted in PLMar as*	Please choose an item from the list.	Student Status upon request*	Please choose an item from the list.

CLEARANCE DETAILS
Office of the University Registrar	Enter details here	Accounting Department	Enter details here
Authentication Code	Enter details here	Authentication Code	Enter details here
Date Cleared	Click or tap to enter a date.	Date Cleared	Click or tap to enter a date.
Remarks	Enter details here	Remarks	Enter details here

ASSESSMENT DETAILS
Assessed by	Enter details here	Total Amount Assessed	Enter details here
Authentication Code	Enter details here	Date Assessed	Click or tap to enter a date.
PAYMENT DETAILS
Recorded/Posted by	Enter details here	Date Paid	Click or tap to enter a date.
Amount Paid	Enter details here	Official Receipt No.	Enter details here
PROCESSING DETAILS
Processed by	Enter details here	Processing Status	Please choose an item from the list.
Authentication Code	Enter details here	Remarks	Enter details here
Date Processed	Click or tap to enter a date.

Important Notes:

Once filled out, please send this form as an attachment to your email to plmar.our.request@gmail.com For Certified True Copy (CTC) and Certification, Authentication, and Verification (CAV) requests, please fill-out the on-line booking schedule form for the submission of documents and payment of requests. See Guidelines on How to Request Certified True Copy (CTC) or Certification, Authentication, and Verification (CAV) on the university website, http://plmar.edu.ph. After paying the assessed amount, please proceed to this link, https://bit.ly/2AxB8eX, for the posting of your payment. In compliance with R.A. No. 10173 (DATA PRIVACY ACT OF 2012), representative must submit a signed authorization letter with original valid ID of both owner/student and representative upon claiming of the requested document(s). Requester will pay the amount of courier services.

REV. afvillodres 06.21.2021

For Accounting use only. Please fill-out the required information. Once the student receives this forms, he/she needs to print and cut all four (4) Orders of Payment and must present this to the Cashier’s Office.
PAMANTASAN NG LUNGSOD NG MARIKINA	PAMANTASAN NG LUNGSOD NG MARIKINA
Accounting Office	Accounting Office
Concepcion Uno, Marikina City	Concepcion Uno, Marikina City
ORDER OF PAYMENT	ORDER OF PAYMENT
Student No.	Enter details here	Student No.	Enter details here
Surname	Enter details here	Surname	Enter details here
First Name	Enter details here	First Name	Enter details here
Middle Name, if any	Enter details here	Middle Name, if any	Enter details here
Degree	Enter details here	Degree	Enter details here
Major	Enter details here	Major	Enter details here
Payment for	Please choose an item from the list.	Payment for	Please choose an item from the list.
Amount Paid	Enter details here	Amount Paid	Enter details here
Official Receipt No.	Official Receipt No.
Date Paid	Date Paid
Authorized by	Arvin Villodres	Authorized by	Arvin Villodres

PAMANTASAN NG LUNGSOD NG MARIKINA	PAMANTASAN NG LUNGSOD NG MARIKINA
Accounting Office	Accounting Office
Concepcion Uno, Marikina City	Concepcion Uno, Marikina City
ORDER OF PAYMENT	ORDER OF PAYMENT
Student No.	Enter details here	Student No.	Enter details here
Surname	Enter details here	Surname	Enter details here
First Name	Enter details here	First Name	Enter details here
Middle Name, if any	Enter details here	Middle Name, if any	Enter details here
Degree	Enter details here	Degree	Enter details here
Major	Enter details here	Major	Enter details here
Payment for	Please choose an item from the list.	Payment for	Please choose an item from the list.
Amount Paid	Enter details here	Amount Paid	Enter details here
Official Receipt No.	Official Receipt No.
Date Paid	Date Paid
Authorized by	Arvin Villodres	Authorized by	Arvin Villodres

Please pay on or before	Click or tap to enter a date.	Accounting Authentication Code	Enter details here

Important Notes:

After paying the assessed amount, please proceed to this link, https://bit.ly/2AxB8eX, for the posting of your payment. In compliance with R.A. No. 10173 (DATA PRIVACY ACT OF 2012), representative must submit a signed authorization letter with original valid ID of both owner/student and representative upon claiming of the requested document(s). Requester will pay the amount of courier services. Students need to wait for the email about the date of release of the requested documents from the Office of the University Registrar.