Ateneo de Manila University

Application Reference #: APP-33360-13708

Ateneo ID No: 170393
Unit: LS
Category: Student
Grade/Year Level (Number only): 1
Course/Section: BS EcE
First Name: Camilo III
Middle Name: Padil
Last Name: Cascolan
Birthdate: 2000-12-13
Gender: Male
Mobile Number: 09164353872
Telephone Number: 9271456
E-mail: ccascolaniii@gmail.com
House No, Street Name, Subdivision: 56-C Esteban Abada St.
Barangay: Loyola Heights
City/Municipality: Quezon City
Province: Benguet
Zip Code: 1108

For Loyola Schools Students only

Student ID Number: 170393

I agree: I am aware of the following regulation and my responsibilities relative thereto:
Students are held responsible for the behavior of persons or outsiders who come
into the campus on their behalf. Bodyguards or chaperons of students are not
allowed inside the campus without proper identification card (ID) issued by the OSS.
Even with proper identification, bodyguards or chaperons (including drivers) are not
allowed to loiter around the campus. The student is charged with an offense when a
violation of the Code of Discipline is committed by such person. (Section 1-H, Code
of Discipline, 2012 Edition, LS Student Handbook) I further attest to the truth and
accuracy of the information contained herein and in the Ateneo Gate Pass Sticker
form, especially given that any form of misrepresentation is considered a major
violation of the Code of Discipline (as per Section III E.3). I also pledge to inform the
Student Services Office and CSMO immediately should there be any changes to the
aforementioned list, as in the case of changes of ownership and/or additional
vehicles applied for.

Vehicle Information

Vehicles Official Receipt or Sales Inv No: 989395271

Vehicles Official Receipt or Sales Inv Date: 2006-08-17
Vehicle Make: Toyota
Vehicle Model: Regius
Vehicle Year: 1995
Vehicle Color: Polar White
Vehicle's Plate No.: REJ898
 Vehicle's Conduction Number:
Vehicle's Special Plate:

Vehicles Official Receipt or Sales Inv No: 148624604

Vehicles Official Receipt or Sales Inv Date: 2005-11-16
Vehicle Make: Ford
Vehicle Model: Explorer
Vehicle Year: 1994
Vehicle Color: Black
Vehicle's Plate No.: RDE731
Vehicle's Conduction Number:
Vehicle's Special Plate:

Vehicles Official Receipt or Sales Inv No: 793244211

Vehicles Official Receipt or Sales Inv Date: 2010-12-13
Vehicle Make: Suzuki
Vehicle Model: NI
Vehicle Year: 2010
Vehicle Color: White
Vehicle's Plate No.: PIA959
Vehicle's Conduction Number:
Vehicle's Special Plate:

The applicant is wholly aware that any misuse of the Traffic Sticker will result in effective suspension
of his/her application.