PRC Central Office:
P. Paredes St., cor Morayta, Sampaloc, 1008 ManilaPhilippines
: www.prc.gov.phTelephone (63-2) 314-00-27
: This application must be filled up in INK and in the applicant's handwriting . All exhibits shall becomepart of the records of the Commission. All applications must be filed
by the applicant.Name of ExaminationDATE of FILING ____________ Date of Examination
____________ Place of Examination
First TimerConditioned/RemovalsPrelimsTheor OnlRepeaterFinals with PrelimsFinalsPractical Only
1.SurnameGiven Name/sMiddle NameMaiden Name
(for married female)
2.Date of Birth (mm/dd/yyyy)3.Place of BirthRurban Code4.Gender
Have you ever been convicted by final judgement by any court of justice/military tribunal or administrative body?NoYes
Please attach copy of decision.
8.Permanent Mailing AddressRurban CodeContact Numbers w/ area code
9.Name of School Graduated10.School AddressPRC School Code11.Degree/CourseCourse CodeBoard Code1213.Review CenterReview Center Code14.No. of Times Exam Repeated15.PREVIOUS PRC EXAMINATION/S TAKEN
Name of Examination
Place of Exam
Date Taken (mm/yy)
FailedI DO HEREBY CERTIFY that the information and statements in this
16.ACTION TAKEN BY THE PROCESSOR
application including the exhibits submitted in support thereof, are all true
ISSUANCE of the FOLLOWING FORMS
and correct of my own knowledge, and that I am fully aware that any falseNotice of AdmissionPermanent Examination Registration Record Cardinformation or statement in this application or in its attachments rendersme liable for criminal prosecution.
I am willing to take a validating examination in case the test results in
my place of examintion are statistically improbable.
17.ACTION TAKEN BY THE LEGAL DIVISION (as applicable)
18.ACTION TAKEN BY THE BOARD
Subscribed and sworn to before me
this _________ day
of __________________ 20 ________ at ________________.
Affiant applicant exhibited to me his/her Community Tax
Certificate No. ________________________________ issuedat ______________________ on __________________.
19.ACTION TAKEN BY THE CASHIER
AMOUNTOfficial Receipt No.COLLECTING OFFICERDate
20.ACTION TAKEN BY THE ISSUING OFFICER
PRC APP Form No.001
PLEASE READ THE REQUIREMENTS, STEPS and other REMINDERS at the BACK
Revised August 2008
Result of Examination
Date of Graduation (mm/dd/yyyy)
DatePlease print this form in a legal size paper havingBEST or NORMAL print setting & FIT to PAPER.
PRC Administering Officer
NOT FOR SALE
REPRODUCTION is ALLOWED
(please mark box)Paste here your recent PASSPORT SIZE colored picture with full name tag in plain white background