CLEARANCE FORM Office Of Registrar | P.O.Box 36711 Lusaka, Zambia | +260 976075850 / +260 953688533 | +260976200094 [email protected] | [email protected] | [email protected] U NIVERSITY of L USAKA (1) STUDENT INFORMATION Names (Mr/Mrs/Ms/Dr):_________________________________________________________________ Student No:____________________________________Cell____________________________________ Email:________________________________________________________________________________ Reason for clearance (Tick): Withdrawing Transferring Graduation Certificate Collection APPROVED BY :_______________________________________________________________________ SCHOOL HOD: I__________________________________________________certify that the student has cleared and submitted the dissertation as required by the University. SIGNATURE____________________ LIBRARIAN: I____________________________________________________ certify that the above student has returned all material to the University. SIGNATURE____________________ ACCOUNTANT: I__________________________________________________ ceritify that the student does not owe the Unversity any fees. SIGNATURE____________________ ACADEMIC OFFICES: I________________________________________________certify that the above student has satisfied all the above requirements and has returned the student identity card to the University. SIGNATURE____________________ (2) OFFICIAL USE ONLY DATE STAMP