Republic of the Philippines

National Police Commission

PHILIPPINES NATIONAL POLICE
HEADQUARTERS HIGHWAY PATROL GROUP
Camp BGen Rafael T Crame, Quezon City

EMCRC APPLICATION FORM

(For Uniformed Personnel)

2x2
picture

Date Accomplished: ___________________

EMCRC Class: _____________

PRINT ALL ENTRIES

1. Rank Last Name First Name Middle Qualifier

2. Badge Number: 3. Designation:

4. Unit Assigned
5. Office Address

6. Home Address

7. Place Of Birth 8. Date Of Birth 9. Age

10. Sex 11.Civil Status 12. Religion

13. Office Telephone No. 14. Cellphone No. 15. E-mail Address

16. Do you have a big bike (400cc up)? ________

If YES, please indicate Make/Type _______________________________

If NO, what is your dream big bike: ____________________________
16. Why do you want to join this training? __________________________________________________

Recommended By:

_______________________________ _______________________________
PNP Police Commission Officer PNP Police Commission Officer
Rider Course Class - __________ Rider Course Class - __________

________________________________
Applicant Signature

APPROVED / DISAPPROVED
 Republic of the Philippines
National Police Commission
PHILIPPINES NATIONAL POLICE
HEADQUARTERS HIGHWAY PATROL GROUP
Camp BGen Rafael T Crame, Quezon City

INFORMATION SHEET
(For Uniformed Personnel)

2x2
picture

Date Accomplished: ___________________

Course: EMCRC

EMCRC Class: _________________________

PRINT ALL ENTRIES

1. Rank Last Name First Name Middle Name Qualifier

2. Badge Number: 3. Designation:

4. Unit Assigned

5. Office Address

6. Home Address (House No. /Street/ Municipal/ City/ Province)

7. Place Of Birth 8. Date Of Birth 9. Age

10. Sex 11.Civil Status 12. Religion

13. Office Telephone No. 14. Cellphone No. 15. E-mail Address
 ____________________________________
Signature Over Printed Name

Republic of the Philippines )

_____________________ ) S.S.

WAIVER

I, one of the
students/participants has agreed to voluntarily undergo the Executive Motorcycle Riding
Course (EMCRC) to be conducted by the PNP-Highway Patrol Group from the period of
, 2020 to , 2020.
That I was appraised/oriented on the dangers of the course and the risk that it
may imposed upon myself and I am still willing to undergo the said course despite the
said risks.
That I will not hold any of the training committee and staff of PNP-Highway Patrol
Group (HPG) who will be responsible in the conduct of the said course not liable should
something happen to me while undergoing the said training.

Execute this day of 2020 at

.

(Signature over Printed Name)

SUBSCRIBE AND SWORN to before me on the date and

________________________________________________________________
______________________________________________________________________
.
Doc. No.
Page No.
Book No.
Series of 2020

TABLE OF CONTENTS

Application Form--------------------- TAB A

Information Sheet -------------------- TAB B

Waiver (Notarized) ------------------ TAB C

Personal Data Sheet ----------------- TAB D

Original Medical Certificate ------- TAB E

(2pcs) 2x2 ID Pictures