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PANUNUMPA NG PROPESYONAL

CLAIM SLIP

Please present this slip at Issuance Window ______________________ to claim your professional identification card on

___________________________.(NOTE: REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT SPECIAL POWER OF ATTORNEY / AUTHORIZATIONLETTER FROM THE REGISTERED PROFESSIONAL). FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.

Ako, si _____________________________________________________, ng___________________________________________________________________________

PRC REG Form No. 001 (Rev. Nov 2007)

(Lagda)

ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, naako ay tunay na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, atmga atas na ipinahayag ng mga sadyang itinakdang may kapangyarihan ng Republika ng Pilipinas;at kusa kong babalikatin ang pananagutang ito, na walang ano mang pasubali o hangaring umiwas.

Taimtim pa rin akong manunumpa na sa lahat ng panahon at pook na kinaroroonan aymahigpit akong manghahawakan sa mga etikal at tuntuning propesyonal ngmga_________________________________ sa Pilipinas, at marapat kong gagampanan ng

(Pook na Sinilangan, Bayan/Lungsod, Probinsya)

buong husay sa abot ng aking makakaya ang mga tungkulin at pananagutang iniatang sa isangitinakdang ____________________.

(Propesyon)

_______________________________

A - _______________________ _____________________ ____________________(Blg. ng Sedula) (Kinuha sa) (Petsa)

Nilagdaan at Pinanumpaan sa harap ko ngayong ika-_________ ng _________________taon ng ating Panginoon _______________sa _________________________, Pilipinas.

(Pinunong Tagapanumpa)_______________________________

(Katungkulang Opisyal)_______________________________

PERSONAL DATATelephone/Contact Number :

Citizenship:

Date of Examination:

Date of Birth:

Spouses Name/Citizenship:

Fathers Name/Citizenship: Mothers Name/Citizenship:

Kasihan Nawa ako ng Diyos.(Propesyon)

NAME:______________________________________________ PROFESSION: _________________________________

REGISTRATION NO. __________________________________ REGISTRATION DATE:___________________________

______________________________________________

Registration Officer

FOR PRC PROCESSING

OK to Pay: ___________________________________

OR No.: _____________________________________

Date Paid: ___________________________________

Profession: __________________________________

Registration No.: ______________________________

Registration Date: _____________________________

SelyoDokumentaryo

Civil Status: Sex:

Paste hereyour recent

PASSPORT SIZEcolored picture in

white background withcomplete name tag

PLEASE FILL OUT THIS CLAIM SLIP

PROCEDURES

Step 1. Accomplish this Oath Form.

Step 2. Pay for two sets of metered documentary stamps (one stamped on this form and onefor the Registration Certificate) at the Customer Service Center.

Step 3. Present duly accomplished oath form (where your profession belongs, for verificationof records and assessment at Window 14, Window 19, Window 28 or at PRC Service Center,Ever-Recto

Step 4. Pay prescribed fees at the Cashier.

Step 5. Sign in the Registry Book and receive your claim slip at:Window 17 Window 20 Window 27

Step 6. Claim your professional ID as scheduled. Please refer to your claim slip forfurther instructions.

REQUIREMENTS

1. Duly accomplished Oath Form or Panunumpa ng Propesyonal2. Current Community Tax Certificate (cedula)3. Two pieces passport size colored picture in white background with complete name tag(for Oath Form and Certificate of Registration)4. One pc. 1x1 colored picture in white background with complete name tag(for Registry of Professionals)5. Two sets of metered documentary stamps (for Oath Form and Certificate of Registration)6. One (1) short brown envelope with name and profession

New registrants should come personally to the PRC Central Office or to the nearestRegional Office to file his/her application for registration and to affix his/her signature on theregistry book.

In case registrant is located abroad, please find below the following requirements :1. Take the professionals oath before the Philippine Consul.2. Special Power of Attorney notarized by the Consul.3. Copy of passport page showing personal data.4. Copy of passport page showing date of entry abroad.

Board Certificates shall be claimed at the Central Office or the Regional Office wherethe application for the same has been filed. Representatives must present Special Power ofAttorney and appropriate identification papers.