PRC CentraI Office: P. Paredes St., Cor. N. Reyes St.

, Sampaloc, 1008 Manila

Philippines Website: www.prc.gov.ph
NOTICE : This application must be filled up in NK and in the applicant's handwriting . All exhibits shall become
part of the records of the Commission. All applications must be filed PERSONALLY by the applicant.
Name of Examination SECOND ENGINEER DATE of FLNG
______________
Date of Examination ____________________________________
PERRC No.: ______________
Place of Examination ____________________________________
First Timer Conditioned
Repeater
1. Surname Given Name/s MiddIe Name
Maiden Name (for married female)
2. Date of Birth (mm/dd/yyyy) 3. PIace of Birth Rurban Code 4. Gender
Male Female
5. CiviI Status 6. Citizenship
Single Married Widow/er Legally Separated
7. LegaI Status
Have you ever been convicted by final judgement by any court of justice/military tribunal or administrative body?
No Yes Please attach copy of decision.
8. Permanent MaiIing Address Rurban Code Contact Numbers w/ area code
Landline
Zip Code Mobile
Email
9. Name of SchooI Graduated 10. SchooI Address SchooI Code
Telephone (632) 733-1046
(please check
box)
PASTE HERE
your recent
PASSPORT SIZE
colored picture
with white
background in proper
uniform, shoulder
board with 3 gold
stripes and complete
name tag.
Type of Examination
AppIication No.________________
ProfessionaI ReguIation Commission
N8fl0 ll00f 0lll00f8 0l9l8l0 N8fl0 ll00f 0lll00f8 0l9l8l0 N8fl0 ll00f 0lll00f8 0l9l8l0 N8fl0 ll00f 0lll00f8 0l9l8l0
NOT FOR SALE
REPRODUCTION is NOT ALLOWED
01l08 $8ll1 01l08 $8ll1 01l08 $8ll1 01l08 $8ll1
9. Name of SchooI Graduated 10. SchooI Address SchooI Code
11. Degree/Course Course Code 12.
13. Review Center Review Center Code 14.Board Code 15. No. of Times Exam Repeated
16. PREVIOUS PRC EXAMINATION/S TAKEN
Name of Examination Place of Exam Date Taken (mm/yy) Failed
17.
TRADE OF
(SEE ATTACHED SHEET F NECESSARY) TOTAL
18. ACTION TAKEN BY THE PROCESSOR
Notice of Admission Permanent Examination Registration Record Card (PERRC)
REMARKS
PROCESSOR
Date
19. ACTION TAKEN BY THE LEGAL DIVISION (as appIicabIe)
REMARKS
LEGAL OFFCER
Date
20. ACTION TAKEN BY THE BOARD
APPROVED DSAPPROVED CONDTONAL
REMARKS
DECLARATION OF NO CONFLICT OF INTEREST
Date
VESSEL/S
NCL CL
YEAR/S
Applicant's Signature
1720
NAME AND
MANNNG COMPANY
NAME OF SHPPNG / KLOWATT
PROPULSON RANK
Rating Passed Verified By
ResuIt of Examination (pls check)
Date of Graduation (mm/dd/yyyy)
ISSUANCE of the FOLLOWING FORMS
MONTHS
Cond.
DAYS
Record of Sea Service/s
CAPACTY /
TYPE OF VESSEL/S
LENGTH OF SERVCE
R|grl
Trurorar|
| 00 hEREY 6ERT|FY lral lre |rlorral|or ard slalererls |r
lr|s app||cal|or |rc|ud|rg lre docurerls suor|lled |r supporl
lrereol, are a|| lrue ard correcl ol ry persora| |roW|edge, ard lral l
ar lu||y aWare lral ary la|se |rlorral|or or slalererl |r lr|s
app||cal|or or |r lre allacred docurerls W||| ru|||ly ry app||cal|or
ard W||| rerder re ||ao|e lor cr|r|ra| prosecul|or.
l rereoy dec|are lral l ar rol currerl|y ard prev|ous|y erp|oyed or correcled |r ary capac|ly
Wralsoever |r a sr|pp|rg/rarr|rg corpary ard rar|l|re scroo|/lra|r|rg/rev|eW cerler/s lral lre app||carl
ras dec|ared |r r|s app||cal|or ard/or lral l ar rol re|aled W|lr|r lre lourlr c|v|| degree ol corsargu|r|ly or
CHARMAN/MEMBER
Date
21. ACTION TAKEN BY THE CASHIER
AMOUNT
Official Receipt No.
Date
COLLECTNG OFFCER
22. ACTION TAKEN BY THE ISSUING OFFICER
REMARKS
SSUNG OFFCER
PLEASE READ THE REQUIREMENTS, STEPS and other REMINDERS at the BACK
PRC Administering Officer
DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED IN THE LIST OF EXAMINEES. DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED IN THE LIST OF EXAMINEES. DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED IN THE LIST OF EXAMINEES. DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED IN THE LIST OF EXAMINEES.
Date
CSS/MLCu
C8 10A/3A2
01/09/10/13
age 1 of 2
0ocurerlary
3larp
8ubscr|be and sworn to before me lr|s ______day
ol___________20_____al_________________.
All|arl app||carl exr|o|led lo re r|s/rer Corrur|ly
Tax Cerl|l|cale No. _____________ ______|ssued
al ___________________ or__________________.
ras dec|ared |r r|s app||cal|or ard/or lral l ar rol re|aled W|lr|r lre lourlr c|v|| degree ol corsargu|r|ly or
all|r|ly. l ar lu||y aWare lral ary v|o|al|or W||| rerder re ||ao|e urder lre re|evarl prov|s|or ol R.A. Z13
ard Jo|rl Reso|ul|or No. 2013-02 3er|es ol 2013 daled Apr|| 25, 2013.
CheckIist of Requirements for SECOND ENGINEER OFFICER (2/E) Licensure Examination (effective January 2012)
1. Properly accomplished and signed Action Sheet (PRC MEO Form No. 03). Please use ballpen in filing up forms.
2. Properly accomplished Application for the ssuance of STCW '95 Certificates (PRC STCW Form No. 18). (OPTONAL)
3. Original and photocopy of Certificates of Completion of the Four (4) Functions of the Revised Management Level Course (MLC).
4. Original and photocopy of Engine Room Simulator Certificate (ERSC) for Management Level Practical Assessment Certificate - taken within the last
five years.
5. Original and photocopy of CURRENT Certificate of Registration (Board Cetificate) as OC-EW.
6. Original and photocopy of NB Clearance valid at least one (1) month from date of examination.
7. Original copy of valid Medical Certificate (PRC MEO Form No. 04) or Original and photocopy of valid Comprehensive Medical Certificate ssued by
DOH accredited Medical Clinics and hospitals.
VALIDITY: Medical Certificate-(PRC MEO Form No. 04 - ( 6 months validity) OR Comprehensive Medical Certificate (1 year validity) - valid for at
least one (1) month after the licensure examination.
8. Original and Photocopy of Community Tax Certificate/Cedula (current year).
9. An approved sea going service of tweIve (12) months either OC-EW, E3, E4, Fourth Engineer/Third Engineer,3rd Assistant Engineer,
2nd Assistant Engineer or combination thereof.(Applicants with promotion on board must present Wages Account, Payslip, or Crewlist on Board as
proof of promotion).
Proof of Sea Service: (9.1 9.4)
9.1 Original Certificate of Sea Service (PRC MEO Form No. 05)
9.1.1 Properly accomplished all data filled in
9.1.2 Certified/Signed by the Master and Chief Engineer Officer of the Vessel and affixed seal of the vessel
9.1.3 Attested by the ship's company or agency
9.1.4 Duly notarized; AND
9.2 Original and Photocopy of Company Certification stating the name and type of vessel, kilowatt propulsion of vessel, trading area, rank occupied
and inclusive dates of sea service. (n case of change of vessel assignment/and or change of name of vessel, please indicate in certification
the name of vessel as per contract, and the name of vessel where he was previously on board)
9.2.1 Signed by the President / Manager / Authorized signatory of the company
9.2.2 Affixed company dry seal
9.2.3 Duly Notarized; OR
9.3 Authenticated copy/ies of Approved POEA Contract of Employment with date of deployment to confirm existence of the ship stated in the
certificate of sea service (for foreign trade) OR Notarized Crew List from the vessel stamped by the Philippine Coast Guard (for domestic
trade); AND
9.4 Original and photocopy of Seaman's dentification Record Book (SRB)
9.4.1 Photocopy of pages 1,2 & 3, and other pages reflecting sea service.( Embarkation and Disembarkation)
10. Four (4) pieces Passport size colored picture: white background, in Proper Merchant Marine uniform, shoulder boards with three (3) gold stripes,
Secure Action Sheet (MEO Form No.3) from the nformation Counter of Marine Engineer Officers Division
and PRC- STCW Form No. 18 (OPTONAL) from STCW Division.
Fill-up Action Sheet and submit it to the Receiving Counter (Window 42) then wait for your name
to be called in the processing counters (Windows 34 to 37) or other designated counter.
8TEP 3. Pay examination fee at the Cashier's Counters (Windows 29 or 30).
8TEP 4. Accomplish all PRC Forms. Copy APPLICATION NUMBER on the Notice of Admission.
8TEP 5. Proceed to the Customer Service Center for the metered documentary stamp and PRC Coop Store for the metered mailing envelope.
8TEP . Proceed to the ssuance Counter (Window 34) or other designated counters.
8TEP 7. Come back to PRC 2-3 working days before the examination date for verification of school/building/room assignment or
visit PRC Website (www.prc.gov.ph).
NO APPLICATIONS SHALL BE ACCEPTED AFTER THE DEADLINE
1. Refer to the MASTERLST of ADDRESS/RURBAN CODES posted at the premises of the filing center for the CODES
of the Town, City or Province of your Residence and Postal Address and Place of Birth. This is different from the ZP CODE.
2. Refer to the MASTERLST of SCHOOL CODES also posted at the filing center for the School/College/University and
Location
3. Refer to the MASTERLST of COURSE CODES posted at the premises of filing center for the Degree and Course Code.
8TEP 2.
8TEP 1.
FOR INTERVIEW OR TO SUBMIT OTHER REQUIREMENTS AS REQUIRED BY THE BOARD OF MARINE ENGINEER OFFICERS.
ANY DEVIATIONS FROM THE ABOVE MENTIONED REQUIREMENTS OR DISCREPANCIES IN SEA SERVICE ARE SUBJECT
S1LS |n ALING for LICLNSUkL LkAMINA1ICN
80888 000l$l$0800l 000l$l0008$l 000l$l8080 000l$
10. Four (4) pieces Passport size colored picture: white background, in Proper Merchant Marine uniform, shoulder boards with three (3) gold stripes,
proper haircut, no head gear, no eye glasses and with complete name tag. (DELA CRUZ, JUAN JR. SALVADOR)
11. One (1) mailing envelope with metered mailing stamp. Pls. pay at the Costumer Service Center,PRC Ground Floor.
12. Examination Fee P900.00 for First Timer and Repeater / P450.00 for Conditioned.
13. Metered Documentary stamp (for Application Form). Pls pay at the Customer Service Center, PRC Ground Floor or at any designated counter.
REPEATER - Certificates of CompIetion of the Four (4) Functions of the Revised Management LeveI Course (MLC), NBI, MedicaI and CeduIa.
) years. 5 ) months if the Iast examination taken is beyond five ( 6 : Must submit current seagoing service of at Ieast six ( NOTE
CONDITIONED - NO NEED to submit sea service. Conditioned Status ONLY vaIid for two (2) years.
3. Refer to the MASTERLST of COURSE CODES posted at the premises of filing center for the Degree and Course Code.
1. Keep and bring your Notice of Admission with Official Receipt.
2. Remember your Application Number, this will be used when you fill up the dentification Sheet on the
first day of examination.
3. Bring pencils (No.1 or 2), ballpen (BLACK ONLY), one piece (1) long brown envelope, one long transparent
plastic envelope.
4. Report to your school assignment before 6:00 am on examination days. LATE examinees will NOT be admitted.
This will mean forfeiture of examination fee.
DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED DO NOT BRING HOME YOUR APPLICATION FORM FOR YOUR NAME WILL NOT BE INCLUDED
IN THE LIST OF EXAMINEES. IN THE LIST OF EXAMINEES. IN THE LIST OF EXAMINEES. IN THE LIST OF EXAMINEES.
IMPORTANT
CSS/MLCu
C8 10A/3A2
01/09/10/13
age 2 of 2