Commission on Higher Education Office of Student Services S tu de nt As s i sta nce an d Ser vi c es Di vi si o n RD 3 H.E.D.C. Building, C.P. Garcia St., UP Diliman Quezon City Tel #: (02)441-1220 Overseas Filipino Workers One-Stop Processing Center (formerly Philippine Seafarers’ One-Stop Processing Center) Title: APPLICATION FORM FOR CERTIFICATION, AUTHENTICATION AND SASD FORM VERIFICATION (CAV) (SASD FORM - 1) (for OFWOSPC use only) Revision No.: 0 Checked by: DSAS Page 1/1 Revision Date: September 11, 2009 Issued by: OSS Name of Applicant Age:_____ Gender: Male Female Present Address: Provincial Address (if _________________________________________________________________ any): _______________________________________________________________ Contact Numbers: ________________________________________________________________ ________________________________ Birth Date: __________________ BirthPlace: ________________________________ Name of School Graduated from: ________________________________________________________________ School Address: Course/s _______________________ Date Graduated: Purpose for applying: Sea based (SRC/SIRB) Others, Please specify _______________ Land based (DFA “red ribbon”) How many copies? _____________ Enclosures (please check upon presentation of the original copy): 1. Official Transcript of Records 3. Certification 2. Diploma 4. Clinical Experience for BSN Applicant’ Signature or Authorized Representative Signature (Printed Name Over Signature) Date Applied: ____________________________ (This portion to be filled-up by CHED-OSS staff) Application Remarks: Received by: _____________________________ fl:CAVformsample.doc JBAG/c:/barry/PSOC Matters/CAVformsmple.doc Requirements: 1. Accomplished Application form (available at www.ched.gov.ph and at the Office of Students Services (OSS)) 2. Two (2) sets of photocopies of Transcript of Records (T.O.R) 3. Two (2) sets of photocopies of Diploma 4. Certification from Higher Education Institution (HEI) Schedule of the Availability of Service: Monday to Friday 8:00 am to 5:00 pm Fees: Php 40.00 per copy Total/Maximum Duration of Process: Fifteen (15) Days Instructions: 1. Files the application to the Student Assistant and Service Division (SASD) Staff, Office of Student Services (OSS). 2. Pays the Fee to the Cashier. 3. Submits the accomplished application form with the attached school credentials and official receipt to the SASD Staff and receives claim stub. 4. Follows-up thru phone to OSS. o If OFW (Sea-based), Picks – up the C.A.V. and documents at the OSS o If OFW (Land-based), follows-up with OSS the Control No. and Houseway Bill and date of release from DFA Picks-up the CAV and documents with red ribbon upon payment to DFA.