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Republic of the PhilippinesRepublic of the PhilippinesRepublic of the PhilippinesRepublic of the PhilippinesRepublic of the Philippines
Professional Regulation CommissionProfessional Regulation CommissionProfessional Regulation CommissionProfessional Regulation CommissionProfessional Regulation Commission
 Manila Manila Manila Manila Manila
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 DATA
Telephone/Contact Number :Citizenship:Date of Examination:Date of Birth:Spouse’s Name/Citizenship:Father’s Name/Citizenship:Mother’s 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 recentPASSPORT SIZEcolored picture inwhite background withcomplete name tagPLEASE FILL OUT THIS CLAIM SLIP
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    mikeo09

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    reply02 / 07 / 2010
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