PERSONAL DATA - PRC - Lucena

PRC Form 203-A
Republic of the Philippines
Professional Regulation Commission
Lucena City
PANUNUMPA NG PROPESYONAL
LUPON ng mga GURO
Ako, si ________________________________________________________
ng _______________________________________________________________________________________
(Pook na Sinilangan: Bayan/Lungsod, Probinsya)
ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na ako’y tunay
na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga atas na ipinahahayag
ng mga sadyang itinakdang kapangyarihan ng Republika ng Pilipinas; at kusa kong babalikatin ang
pananagutang ito, na walang ano mang pasubali o hangaring umiwas.
Taimtim pa rin akong nanunumpa na sa lahat ng panahon at pook na kinaroroonan ay mahigpit akong
manghahawakan sa mga etikal at tuntuning propesyonal ng mga GURO sa Pilipinas, at matapat kong
gagampanan ng buong husay sa abot ng aking makakaya ang mga tungkulin at pananagutang iniatang sa
isang itinakdang GURO.
Kasiyahan Nawa Ako ng Diyos.
A- ________________________
(Bilang ng Sedula)
__________________________
(Kinuha sa)
__________________________________
(Lagda)
_______________________
(Petsa)
Nilagdaan at Pinanumpa sa harap ko ngayong ika _________ ng ______________________________
taon ng ating Panginoon _____________ sa _____________________________, Pilipinas.
Level Elem Sec
Reg/Lic. No. ______________
Reg. Date ________________
O.R. No. _________________
Date Paid ________________
Verified and Assessed By: ______________
Date of Examination: LET _____________________
Contact No.: _____________________
Sex:
Metered
Documentary
Stamp
Male
Female
Father’s Name Citizenship:
COLORED
PICTURES
In plain
background
with complete
name tag
PASTE HERE
Civil Status:
Single Widow/er
Married Separated
PERSONAL DATA
WITHOUT EXAM:
Date of Birth:
Spouse Name Citizenship:
Mother’s Name Citizenship:
_______________________________
(Pinunong Tagapanumpa)
_______________________________
(Katungkulang Opisyal)
Resolution No.: ________________
Dated: _______________________
TEAR HERE
C L A I M S L I P
Serial # _____________
Name:____________________________________ LEVEL: Elementary Secondary
Registration / License No.:____________________ Major: ________________
Please present this slip to claim your professional ID after 3 to 4 months at Windows 6.
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
*** Please read procedures and requirements at the back.
_________________________
OPT Registration Officer
COLORED
PICTURES
In plain
background
with complete
name tag
PASTE HERE
__________
Date
========================================================================================================================================
2/F LUCENA GRAND CENTRAL TERMINAL, INC., ILAYANG DUPAY, LUCENA CITY, PHILIPPINES
(042) 373-7316 FAX (042) 373-7305 www.myprclucena.multiply.com

REGISTRATION OF NEW PROFESSIONAL
PROCEDURES
STEP 1 Accomplish the Oath Form
STEP 2 Pay for metered documentary stamps at the Customer Service Center
STEP 3 Present duly accomplished Oath Form to the OPT Registration Officer at OPT
Window for record verification
STEP 4 Pay the prescribed fees at the Cashier (Window 17)
STEP 5 Sign in the Registry Book, receive your claim slip at OPT Window
STEP 6 On scheduled date, present your CLAIM SLIP at OPT Window (Window 6) to
claim your Professional ID and Certificate of Registration.
REQUIREMENTS
Duly accomplished Oath Form or Panunumpa ng Propesyonal
Metered Documentary Stamps for the Oath Form
Current Community Tax Certificate (CEDULA)
Two (2) pieces passport size pictures with white background and complete name tag
(last name, first name, middle name) one (1) for the Oath Form & the other for
Board Certificates)
One (1) pc 1x1 picture with white background and complete name tag
IMPORTANT
Initial registrants should come personally to the PRC Central Office or the nearest
Regional Office to file his/her application for registration and affix his/her signature on the
Registry Sheet.
Professional Identification Card and Certificate of Registration shall be claimed by
the licensee personally at the Central Office of the Regional Office where the application
for the same has been filed. If there is an unavoidable need for a representative, he must
present his identification paper and Special Power of Attorney from the registrant/licensee.
(Office order No. 36 dated April 02, 2002)
NOTE: REPRESENTATIVE WITH VALID ID SHOULD PRESENT SPECIAL POWER
OF ATTORNEY FROM THE REGISTERED PROFESSIONAL AND THIS
ORIGINAL CLAIM SLIP. PROFESSIONAL WITH UPDATED PRC ID WHO IS
ACTING REPRESENTATIVE MAY ONLY PRESENT AUTHORIZATION
LETTER AND HIS/HER ID AND THIS ORIGINAL CLAIM SLIP) (as per
OFFICE ORDER 2003-164 dated October 07, 2003)