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    04 002 PRC Renewal Form

    Uploaded by

    Joy Agnez Bangalisan-Gramata
    This document outlines the procedures for renewing or replacing a professional identification card from the Professional Regulation Commission of the Philippines. It provides instructions on completing an application form, submitting requirements like photos and copies of licenses, paying fees at the cashier, and claiming the identification card at specified windows and dates according to the claim slip. Proper identification is needed if sending a representative to claim the card.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    04 002 PRC Renewal Form

    Uploaded by

    Joy Agnez Bangalisan-Gramata
    692 views2 pages
    This document outlines the procedures for renewing or replacing a professional identification card from the Professional Regulation Commission of the Philippines. It provides instructions on completing an application form, submitting requirements like photos and copies of licenses, paying fees at the cashier, and claiming the identification card at specified windows and dates according to the claim slip. Proper identification is needed if sending a representative to claim the card.

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    This document outlines the procedures for renewing or replacing a professional identification card from the Professional Regulation Commission of the Philippines. It provides instructions on completing an application form, submitting requirements like photos and copies of licenses, paying fees at the cashier, and claiming the identification card at specified windows and dates according to the claim slip. Proper identification is needed if sending a representative to claim the card.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    692 views2 pages

    04 002 PRC Renewal Form

    Uploaded by

    Joy Agnez Bangalisan-Gramata
    This document outlines the procedures for renewing or replacing a professional identification card from the Professional Regulation Commission of the Philippines. It provides instructions on completing an application form, submitting requirements like photos and copies of licenses, paying fees at the cashier, and claiming the identification card at specified windows and dates according to the claim slip. Proper identification is needed if sending a representative to claim the card.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    TO BE ACCOMPLISHED PERSONALLY BY THE PROFESSIONAL

    Republic of the Philippines Professional Regulation Commission Manila

    PRC REG Form No. 003 (Rev.Sept.2004)

    RENEWAL DUPLICATE REPRINT CHANGE OF NAME NAME:


    Last Name

    REGISTRATION DIVISION APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD


    ,
    First Name Middle Name

    Paste here Your recent PASSPORT SIZE Colored picture in White background with complete name tag

    PERMANENT MAILING ADDRESS: DATE FILED:


    (mm/dd/yy)

    PROFESSION: LICENSE NO.


    (mm/dd/yy)

    EXAM DATE:
    (mm/dd/yy)

    REGISTRATION DATE: CITIZENSHIP:

    EXPIRATION DATE:
    (mm/dd/yy)

    BIRTH DATE:
    (mm/dd/yy)

    TEL. No./CP No.: _________________________________


    SIGNATURE OF LICENSEE FOR PRC PROCESSING

    This is to certify that all the information above are true and correct.

    YLP FROM: ______________ TO: ______________ P/ ______________ SURCHARGE: ______________ TOTAL AMOUNT: ______________ VERIFIED AND ASSESSED BY: ________________________________

    Amount: _______________________ Date:__________________________

    O.R.No.: ______________________ Issued by: _____________________

    PLEASE FILL OUT THIS CLAIM SLIP ISSUED BY:______________________________________


    NAME: PROFESSION: LICENSE NO.: APPLICATION TYPE: RENEWAL DUPLICATE

    ID CLAIM SLIP
    DATE FILED: ______________________________________
    AMOUNT: OR NO. DATE PAID: REPRINT CHANGE OF NAME

    Please present this slip to claim your professional ID on ______________________________ at Window ____________________________________ (NOTE: REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT SPECIAL POWER OF ATTORNEY/AUTHORIZATION LETTER FROM THE PREGISTERED PROFESSIONAL AND THIS ORIGINAL CLAIM SLIP.) FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.

    PROCEDURES

    Step 1: Step 2: Step 3: Step 4:

    Present duly accomplished form together with the requirements at Assessment Windows Window 16 Window 18 Window 30 Pay prescribed fees at the Cashier Get your claim slip at Windows 16, 18 and 30 Claim your professional license as scheduled. Please refer to your claim slip for further instructions.

    REQUIREMENTS 1. 2. 3. 4. 5. Duly accomplished form Two (2) pcs passport size picture: close up, colored, white background with complete name tag Photo/xerox copy of recent professional ID card In case of LOST professional ID card which is still current, the applicant shall submit notarized Affidavit of Loss In case of DESTROYED professional ID card, the applicant shall surrender the destroyed card

    NOTE: As the authorized representative, I assume direct and full responsibility/liability for the security of the professional ID. __________________________________
    Signature over Printed Name of REPRESENTATIVE

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