PRC REC Form No.

001 (REV 09 JULY 2009)

Republic of the Philippines

PURPOSE:
LOCAL
ABROAD

Professional Regulation Commission

Lucena City

RECORDS MANAGEMENT DIVISION

ACTION SHEET

DATE FILED: __________________________

DATE OF RELEASE:_____________________
NAME OF APPLICANT:

PROFESSION: _________________________
REG. NO.: ____________________________
REG. DATE: ___________________________
DATE GRADUATED:_____________________

ORIGINAL CERTIFICATION
AUTHENTICATION

LAST NAME

FIRST NAME
DATE OF BIRTH:

NAME OF BOARD EXAM TAKEN:

DATE OF EXAM:
(mm/yyyy)
FOR TEACHERS ONLY: Place of Exam:
LEVEL:
ELEMENTARY
SECONDARY

MIDDLE NAME
CONTACT NUMBER:
(P75.00/copy)

NO OF COPIES:

CERTIFICATION REQUESTED (PLEASE CHECK)

FOR AUTHENTICATION

Board Rating
Passing
Good Standing

Others (Please Specify):

ID CP/CBR/CGS
Board Certificate

Amount:

FOR PRC PROCESSING

Received by:

For Certification without Examination

O.R. No:

Verified by:

Resolution No.

Date:

Encoded by:

Date:

Issued by:

Released by:

Verified by:

Professional Regulation Commission

Lucena City
DATE
FILED: __________________________

CLAIM SLIP

ORIGINAL CERTIFICATION
AUTHENTICATION

NAME OF APPLICANT:
Last Name
PROFESSION: __________________________ DATE OF EXAM: ______________________
(mm/yyyy)
REQUESTED DOCUMENT/S:_____________________________ No. of Copies:___________
(PLEASE SPECIFY)

First Name

Middle Name
OFFICIAL RECEIPT No:____________________________
Amount Paid:______________ Date:__________________

Please present this slip to claim document/s at WINDOW - _________ on __________________________.

Contact No. (042) 373.7316
REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT AUTHORIZATION LETTER AND VALID IDENTIFICATION CARD FROM THE REQUESTING PARTY.

CERTIFICATION/AUTHENTICATION OF LICENSURE EXAMINATION RESULTS

(Board Rating, Passing, Good Standing)

REQUIREMENTS
1.
2.
3.
4.
5.

Photocopy of valid professional license and claim stub in case of PRC I.D. was renewed and under
process.
Duly accomplished Action and claim stub in case of PRC I.D. was renewed and under process.
Duly accomplished Action Sheet.
PRC Official Receipt.
For authentication, ORIGINAL AND PHOTOCOPIES of documents to be authenticated.

PROCEDURE
Step 1.
Step 2.
Step 3.
Step 4.

Step 5.

NOTE:

Present the accomplished Action Sheet (AS) at designated window for assessment of fee.
Pay certification/authentication fee (P75.00 / copy) at the Cashier (Window 17)
Secure documentary stamp at the customer service (in front of Window 17)
Present duly accomplished AS together with the requirements at designated window to get your claim
slip.
Window 2 Unit C (Technology/Engineering/Business/Social w/ selected health professions)
Window 3 Unit B (Health w/ selected technology/engineering professions)
Window 7 Unit A (Teachers)
On due date, present your Claim Slip at designated window and receive documents.

Original Certifications not claimed within six (6) months from the date of scheduled release
shall be disposed of.