Online Document Request Form

SCHOOL YEAR*

If the requester is no longer at CSI, write the last school year at CSI

COMPLETE NAME OF STUDENT (FAMILY NAME/FIRST NAME/MIDDLE NAME)*

GRADE AND SECTION*

If the requester is no longer at CSI, write the last grade and section attended

COMPLETE ADDRESS*

MOBILE NUMBER*

E-MAIL ADDRESS*

DOCUMENT/S REQUESTED

Form 137 (Elementary/JHS: P100.00 | SHS: P200.00. Note: If it is required to submit the e-copy of the document, the fee shall be doubled)
Certified True Copy of Form 138 (Bring the photocopy of the Form 138/report card and pay P50.00)
Certificate of Enrollment (P100.00)
ESC Certificate (No charge)
Certificate of Good Moral Conduct (P100.00)

If requesting for other document/s not mentioned above, please specify the document/s below.

Note: Report Card and Diploma/Completion Certificate are only issued once. However, in case of loss, you may request another copy upon submission of a notarized affidavit of loss. Fee: Report Card - P100.00 | Diploma - P200.00 | Certificate of Completion - P150.00

Purpose of Request*

School where you intend to Study*

How would you like CSI to issue your requested document/s? **

Send the scanned copy of the document/s to the email address provided
Issue the hard copy of the document/s to the Official Representative
Have the document/s delivered via courier (CSI charges the cost of delivery to the requester. Please send your complete mailing address and contact number to csi.officeoftheregistrar@gmail.com)

How do you intend to pay for the document/s?*

Pay via bank deposit or online transfer at the following bank accounts: BPI Family Account Name: Church Among the Palms, Inc-CSI -- Account Number: 5805-0488-77 | China Bank Savings Account Name: CAP-CSI -- Account Number: 6188-0000-9948 | Note: Please send the proof of payment to csi.financeoffice@gmail.com and csi.officeoftheregistrar@gmail.com
Pay onsite at CSI from Monday to Friday, 8:00 AM to 4:00 PM

OFFICIAL REPRESENTATIVE*

Please write the name of the student's Official Representative. Please take note that this person, identified as the Official Representative of the student, is the only one allowed to pick up the hard copy of the document/s on behalf of the student. Write "NA" if the requester is the owner of the document.

Relationship of the Official Representative to the Student*

Official Representative's Mobile Number*

Official Representative's Email Address*

Date Requested*

ID NO. 402522

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