Office of the Secretary of the University
University of the Philippines System
Records Section
Record Request No.
________________
RECORDS REQUEST FORM
Please fill out this form completely with as much details as possible to help us identify specifically
the records you are requesting. The records section staff is available to assist you in identifying the
records you need.
The records Section may need some time to locate and review documents that are responsive to your
request.
REQUESTER INFORMATION
Name:____________________________________________________ Date:__________________
Campus:__________________________________________________ Unit:__________________
Contact Number:___________________________________________ Email:_________________
REQUESTED RECORDS/DOCOUMENTS
PURPOSE:
_____________________________________________
_____________________________
_____________________________________________
_____________________________
_____________________________________________
_____________________________
RELEASED BY
Releasing Staff:_____________________________________________ Date:__________________
Received by:_______________________________________________ Date:__________________