UNIVERSITY OF SANTO TOMAS Office of the Vice Rector for Finance APPLICATION FOR REFUND OF FEES (Under the Pandemic) I, Reantazo, Keane Danielle C. a student of the college/faculty/school of BS Elementary Education hereby apply for a refund of part of my fees and/or fee adjustments for the reason that (check appropriate blank below): I graduated/met all the academic requirements for graduation at the end of the ____________Term of AY 2019-2020 and had paid fully my accounts for that term I am currently enrolled as a _____ year student and have fully settled my accounts for the 2nd Term of AY 2019-2020, Special Term of AY 2019-2020, (if applicable), and the 1st Term AY 2020-2021 I am not currently enrolled but have fully settled my accounts as a 1st year student in the 2nd Term AY 2019-2020 and/or Special Term AY 2019-2020 (if applicable) Refundable amounts exceed all my remaining balances in the previous term(s) I wish to claim my refunded amount through (check appropriate blank): Transfer Bank Bank Name/Branch: METROBANK Account Name: Cherry Reantazo Account Number: 3013735233441 To be claimed from the UST Cashier’s Office Check 2nd floor, Main Building, UST Campus (if allowed by quarantine level conditions) I wish to claim my refunded amount through (check appropriate blank): Bank Transfer Bank Name/Branch: METROBANK Account Name: Cherry Reantazo Account Number: 3013735233441 To be claimed from the UST Cashier’s Office _____ Check 2nd floor, Main Building, UST Campus (if allowed by quarantine level conditions) Reantazo, Keane Danielle C. Signature of student 5/29/2021 Date Reantazo, Cherry Chua Signature of parent over printed name STUDENT NUMBER: 2019131681 CERTIFICATION This is to certify that based on records and per computation, the total amount to be refunded to the aforementioned student is _________________________________________________. Prepared by: _________________________ Staff in Charge Checked and Verified by: Approved by: _______________________________ Supervisor, Student Accounts Section _________________________ S Vice-Rector for Finance UST:S004-04-FOO7