APPOINTMENT DATE: Dec 19, 2019 (11:00 AM TO 12:00 PM) - PRC San Fernando

REFERENCE NO: INAGEE6IPQQV | OR: - | AMOUNT: PHP -

NOT FOR SALE (REPRODUCTION IS ALLOWED)

Republic of the Philippines

Professional Regulation Commission
Manila Paste here
your recent
PASSPORT SIZE
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PANUNUMPA NG PROPESYONAL with complete
name tag

CARLO MENDOZA BALLON

Ako, si ______________________________________________________________________, ng
_____________________________________________________________________________________
OLONGAPO CITY, ZAMBALES
(Pook na Sinilangan, Bayan/Lungsod, Probinsya)
ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na ako ay
tunay na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga 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 ay mahigpit

akong manghahawakan sa mga etikal at tuntuning propesyonal ng mga
____________________________ sa Pilipinas, at marapat kong gagampanan ng buong husay sa abot ng
(Propesyon)
aking makakaya ang mga tungkulin at pananagutang iniatang sa isang itinakdang
________________________.
(Propesyon)

Kasihan Nawa ako ng Diyos.

______________________________________
( Lagda)
01331854
A - ____________________________ SUBIC, ZAMBALES
_______________________ Apr 04, 2019
_________________________
(Blg. Ng Sedula) (Kinuha sa) (Petsa)

Nilagdaan at Pinanumpaan sa harap ko ngayong ika-____________ ng ________________________

taon ng ating Panginoon _____________________ sa ___________________________, Pilipinas.

FOR PRC PROCESSING

-
OK to Pay: __________________________________ __________________________________
Selyo -
OR No.: _____________________________________ (Pinunong Tagapanumpa)
Dokumentaryo -
Date Paid: ___________________________________
Profession: __________________________________ __________________________________
Registration No.: ______________________________ (Katungkulang Opisyal)
Registration Date: _____________________________

PERSONAL DATA
Telephone/Contact Number: 09163296632 Date of Examination:
Citizenship: FILIPINO Date of Birth: Sep 11, 1992
Civil Status: SINGLE Sex: MALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: CARLITO T. BALLON SR. / FILIPINO Mother’s Name/Citizenship: YOLANDA M. BALLON (DECEASED) / FILIPINO

PLEASE FILL OUT THIS CLAIM SLIP

CLAIM SLIP

CARLO MENDOZA BALLON

NAME: _______________________________________ PROFESSION: _________________________________
REGISTRATION NO. ____________________________ REGISTRATION DATE: __________________________
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/ AUTHORIZATION
LETTER FROM THE REGISTERED PROFESSIONAL). FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.

____________________________________________
(Registration Officer)

REG- 01
Rev. 00
February 25, 2015
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