Republic of the Philippines Professional Regulation
Commission
Lucena City
RECORDS MANAGEMENT DIVISION
A C T I O N S H E E T
NAME OF APPLICANT: LAST NAME FIRST NAME MIDDLE NAME
NAME OF BOARD EXAM TAKEN: DATE OF BIRTH: CONTACT NUMBER:
DATE OF EXAM: CERTIFICATION REQUESTED (PLEASE CHECK) NO OF
COPIES: (P75.00/copy) (mm/yyyy) Board Rating FOR AUTHENTICATION
Others (Please Specify): FOR TEACHERS ONLY: Place of Exam: Passing
ID CP/CBR/CGS LEVEL: ELEMENTARY SECONDARY Good Standing Board
Certificate
FOR PRC PROCESSING
Amount:
Received by:
For Certification without Examination
O.R. No:
Verified by:
Resolution No.
Date:
Encoded by:
Date:
Issued by:
Released by:
Verified by:
Professional Regulation Commission
Lucena City
NAME OF APPLICANT: Last Name First Name Middle Name
Please present this slip to claim document/s at WINDOW -
_________ on __________________________. Contact No. (042) 373.7316
REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT
AUTHORIZATION LETTER AND VALID IDENTIFICATION CARD FROM THE
REQUESTING PARTY.
PRC REC Form No. 001 (REV 09 JULY 2009)
PROFESSION: _________________________
REG. NO.: ____________________________
REG. DATE: ___________________________
DATE GRADUATED:_____________________
DATE FILED: __________________________
DATE OF RELEASE:_____________________
ORIGINAL CERTIFICATION
AUTHENTICATION
ORIGINAL CERTIFICATION
AUTHENTICATION
OFFICIAL RECEIPT No:____________________________
Amount Paid:______________ Date:__________________
DATE FILED: __________________________ C L A I M S L I P
PURPOSE:
LOCAL ABROAD
PROFESSION: __________________________ DATE OF EXAM:
______________________ (mm/yyyy)
REQUESTED DOCUMENT/S:_____________________________ No. of
Copies:___________ (PLEASE SPECIFY)
CERTIFICATION/AUTHENTICATION OF LICENSURE EXAMINATION
RESULTS
(Board Rating, Passing, Good Standing)
REQUIREMENTS
1. Photocopy of valid professional license and claim stub in
case of PRC I.D. was renewed and under process.
2. Duly accomplished Action and claim stub in case of PRC I.D.
was renewed and under process. 3. Duly accomplished Action Sheet.
4. PRC Official Receipt. 5. For authentication, ORIGINAL AND
PHOTOCOPIES of documents to be authenticated.
PROCEDURE
Step 1. Present the accomplished Action Sheet (AS) at designated
window for assessment of fee.
Step 2. Pay certification/authentication fee (P75.00 / copy) at
the Cashier (Window 17)
Step 3. Secure documentary stamp at the customer service (in
front of Window 17)
Step 4. Present duly accomplished AS together with the
requirements at designated window to get your claim slip.
Window 2 Unit C (Technology/Engineering/Business/Social w/
selected health professions) Window 3 Unit B (Health w/ selected
technology/engineering professions) Window 7 Unit A (Teachers)
Step 5. On due date, present your Claim Slip at designated
window and receive documents.
NOTE: Original Certifications not claimed within six (6) months
from the date of scheduled release
shall be disposed of.
