This serves as OFFICIAL RECEIPT if
UPLB FORM 5. UNIV. OF THE PHIL. LOS BAÑOS CERTIFICATE OF REGISTRATION (Rev. 2002) an  amount  is  printed   thru   cash
WRITE BLOCK LETTERS. Use "X" mark in answering information preceded by a box. register.
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 STFAP NO. TOTAL AMT. REASSESSMENT

SUBJECTS Units Section College Degree Term/School Year Tuition
Misc
Country of
Citizenship: 		Std. Fund
Lab Fee
STFAP Bracket No:
Certified by: _______________________
(OSA Staff)

OTHER SCHOLARSHIP
_________________________________ 		Ent/Dep
NSTP
Fine
TOTAL FEES
AMT. PAYABLE
SIGNATURE OF STUDENT:


Plus EDF
(Amt. Paid For Tuition and Other Fees)


__________________________________________________
COLLECTED BY (Date) (C.R. NO.) (Amt. Paid)
REASSESSED BY: __________________
AUDITED BY: _____________________
Total Units





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) 		      "In consideration of my admission to the University of the Philippines Los Baños and of  the previleges of a student in this institution, I hereby promise and pledge to abide by and  comply with all the rules and regulations laid down by competent authority in the  University and in the college or school in which I am enrolled." (Amt. Paid For Tuition and Other Fees)



__________________________________________________
COLLECTED BY (Date) (C.R. NO.) (Amt. Paid)
_________________________________
Signature of Student

Date of Birth: College: Degree: Major:
STATUS: Single Married SEX: Country of Citizenship: Term/School Yr.
STFAP NO.
TOTAL AMT.








SUBJECTS
(CRSE NO.) 		Final
Grade 		Units Section LECTURE
Time - Day - Room 		LABORATORY
Time - Day - Room 		Lab Fee REASSESSMENT








Tuition
Misc
Std. Fund
Lab Fee
Ent/Dep
NSTP
Fine
TOTAL FEES
AMT. PAYABLE
Plus EDF
(Amount Paid for EDF)

________________________________________________
COLLECTED BY (Date) (C.R. NO.) (Amt. Paid)
Total No. of Units: ANNUAL FAMILY GROSS INCOME P____________________
1ST TIME TO ENROLL IN UP? YES NO STFAP Bracket No:
Certified by: ________________________
(OSA Staff)

OTHER SCHOLARSHIP 		REASSESSED BY:



__________________________
GRADUATING THIS 1ST 2ND SUMMER
TYPE: CLASSIFICATION:
College Addr. _______________________________________________
Prov'l Addr. _________________________________________________
                    _________________________________________________
Tel. No. ___________________________ Zip Code _________________

Adivser (if any) ______________________________________________

 Parent/Guardian/Spouse (encircle one)

Name ___________________________________ Tel No. _________________
Mailing Address ___________________________________________________
___________________________________ Zip Code _____________________

I hereby Certify that all the information given in this form are true and correct.


__________________________
Signature of Student


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