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.