CSC ERRF FORM

ERRFExamination Records Request Form (ERRF)Republic of the Philippines(July 2009)OFFICE NAMEDate:CIVIL SERVICE COMMISSIONTime:REQUEST FOR EXAMINATION RECORDSCertification of EligibilityAuthentication of EligibilityVerification of EligibilityOthers:(for lost original certificate)(attach original certificate)PERSONAL INFORMATION (Please print.)Name of Examinee/Eligible:Last NameFirst NameMiddle NameAddress Used at the Time of Exam:Gender:Name Used at the Time of Exam (for Married Women):Civil Status:Date of Birth:Place of Birth:Current/Mailing Address:Purpose of Request:Presently employed? (Yes or No)If yes, specify Employer and Address:EXAMINATION/ELIGIBILITY DATA (Please print.)Title of Exam/Eligibility:Place of Exam/Issuance:Date of Exam/Issuance:Rating Obtained:Reg. No. for PD 1006/RA 1080/Other Special Laws:Registration Date:(Failure to fill up this portion shall mean denial of the request)Requested By:Signature of theSignature at the Time of ExamAuthorized Representative (Printed Name and Signature)Examinee/EligibleRight Thumb PrintContact No.(Examinee/Eligible)Contact No.ACTION TAKENCHECKED DATA AGAINST THE MLCHECKED DATA AGAINST THE PSPBook No. Page No. Seq./Line No.In OrderNot In OrderSchool Code/Batch No. Examinee/Reg. No.Picture/PhotoDate Released:SignatureNO AVAILABLE RECORDDate of BirthREMARKSSECURITY FORM NO.Name/Signature/Initial of Verifiers and Validators:1st Verifier:2nd Verifier:1st Validator: 2nd Validator:Date:Date:Date:Date:Attested by: ___________________RELEASE OF REQUEST/SReleased byReceived byFeeO.R. No.Date:_______Date:Action OfficerPrinted Name & Signature of CllientTime:_______(Please see Guide and Requirements at the back page.)

GUIDEGUIDE IN ACCOMPLISHING THE EXAMINATION RECORDS REQUEST FORM (ERRF)1. Do not leave any blank unanswered in accomplishing the request form.2. Make sure that all information you provide are true and as written in your application for examination.3. Right thumb print are clear and without smudges.CHECKLIST OF REQUIREMENTSA. CERTIFICATION OF ELIGIBILITY (for lost original certificate)1. One piece "1 inch by 1 inch" picture with name tag and signature affixed prior to having the photograph taken* Signature must be on top of the printed name.* The photograph should have been taken within three (3) months prior tofiling of request for Certification of Eligibility.* Scanned, computer-generated photo/name/signature will not be accepted.2. Properly accomplished ERRF3. Two (2) valid Identification Cards4. Certification fee: Php100.00 per copy5. If through a representative or if the requesting party is abroad, please refer to additional requirements below.B. AUTHENTICATION OF ELIGIBILITY1. Original Certificate of Eligibility or Report of Rating2. Properly accomplished ERRF3. One (1) valid Identification Card (if requesting party is the examinee/eligible)Two (2) valid Identification Cards of the examinee/eligible (if request is filed through a representative)4. Authentication fee: Php50.00 per copy5. If through a representative or if the requesting party is abroad, please refer to additional requirements below.Choices for Identification Card/s:1. Company ID4. Voter's ID7. Driver's License10. NBI Clearance2. Taxpayer's ID5. SSS ID8. PRC License11. Police Clearance3. Passport6. GSIS ID9. NBT LicenseADDITIONAL REQUIREMENTSA. If request for certification or authentication is filed through a Representative:1. Authorization Letter or Special Power of Attorney (SPA); and2. One (1) valid Identification Card of the representative.B. If the requesting party of the certification or authentication Works/Lives Abroad:1. Copy of Passport; and}duly authenticated/validated by the Philippine Embassy or2. Copy of one (1) Identification Card.}Consular Office