CERTIFICATION / UNDERTAKING
I, ___________________________________________________, of legal age, Filipino, with residence and postal
address at__________________________________________________, hereby certify THAT:
1. I am an enrollee of Polytechnic University of the Philippines (PUP),
(Please check one): Sta. Mesa, Manila
Branch/Campus:_____________________________
(State the Branch/Campus)
2. In compliance with the documentary requirements of the aforementioned University, among others, I
am submitting/undertake to submit the following documents on the date of enrollment:
a. Original Senior High School Card (R138 / Grade 12 Card)
b. Original or certified true copy of grade 10 & 11 high school card.
c. Notarized certification of non-enrollment for high school/senior high school graduates who
have not enrolled in any technical/diploma/degree program immediately after graduation.
d. Original PSA Birth Certificate.
e. Certificate of Good Moral issued by the SHS Principal/or Guidance Counselor with school dry
seal.
f. Duly signed Certification Under Oath, Form 2
g. Two (2) pcs. 2 in. x 2in. colored picture with white background with applicant’s name on the
photo.
h. One (1) pc. Long brown envelope.
For Senior High School Graduates/High School Graduates of Past School Year/s
In addition to the above admission requirements:
i. Certification from senior high school registrar with school dry seal and noted by the Principal
that no copy of F137A has been sent to other college or university.
j. Notarized certification of non-enrollment for senior high school graduates who have not
enrolled in any technical/diploma/ degree program immediately after graduation with “waiver”
that if there is concealment of previous enrollment, PUP enrollment becomes null and void.
For Graduates of Alternative Learning System
a. Certificate of Completion
b. Certificate of Rating
c. Verified/ Certified True Copy of National List of Passers which shows the name of the
applicant.
d. Certificate of Good Moral Character issued by the school last attended
e. Original PSA Birth Certificate
f. Two (2) pcs of 2x2 inches colored picture with white background and with the applicant’s name
of the photo.
g. One (1) pc. Long brown envelope
3. I vouch the authenticity and genuineness of the documents I submitted/ will submit to PUP;
4. I undertake and assume full and complete responsibility for all the consequences which may arise in
case any of the documents I submitted is found to have been falsified or fabricated.
5. I VOUCH THAT I HAVE NOT ENROLLED IN ANY HIGHER EDUCATION INSTITUTION INCLUDING ANY
BRANCH OR CAMPUS OF PUP OTHERWISE MY ENROLLMENT WILL BE CANCELLED.
6. I understand that my admission is merely provisional and that the University reserves its right to deny
my application for enrollment or revoke my enrollment should be information I declared or documents
submitted have been found to be deceitful, fabricated and falsified without prejudice to filing a
criminal case against me; and
7. I am executing this Undertaking in order for the University to proceed with mu enrollment.
______________________________________________________
Signature above Printed Name of Enrollee
Date:________________________
ATTESTED by:
_____________________________________________________
Signature above Printed Name of Parent/ Guardian
These documents contain personal-identifiable information that is subject to Data Privacy.
Please keep these documents protected and in a safe place.
ROUTE AND APPROVAL SLIP
ACADEMIC YEAR 2023-2024
Name of
Applicant:_______________________________________________________________________________________________
Reference Number:____________________________________Date of
Enrollment:___________________________________________
SHS
Track/Strand:_____________________________________________________________________________________________
The application for admission and enrollment shall be processed and approved only upon compliance to the following
requirements:
Step 1: Submission of admission credentials at the Admission and Registration Services Section
Processed by: Remarks:
Grade 12 GWA: _______________________
SHS Strand:__________________________ Non-SHS
Admission Status:
CAEPUP Qualifier PUPLHS/SHS Indigenous People
Academic Scholar Athlete SK Official
Artist Journalist Others
___________________________ ___________________________
ALS PWD
Signature Date
Step 2: College Interview and Tagging of Program (This shall be filled-out by the interviewer only if the applicant is qualified)
Interviewed by:
___________________________ ___________________________ Program:__________________ Section:___________________
Signature Date
Step 3: Medical Examination
Submission of Chest X-ray with film and Health Information Remarks:
Form for Students. (Validity of the Chest X-ray result should
be not more than 6 months from the scheduled enrollment)
Processed by:
___________________________ ___________________________
Signature Date
Step 4: Printing of Registration Certificate
Issued by:
___________________________ ___________________________
Signature Date
Step 5: Printing and Claiming of Identification Card
These documents contain personal-identifiable information that is subject to Data Privacy.
Please keep these documents protected and in a safe place.
