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Republic of the Philippines

Professional Regulation Commission


Manila

CERTIFICATION

I hereby certify that the attached documents consisting of __________ pages, truthfully reflect the related learning experience, and the minor/major surgery
and delivery room cases, I have participated in, at the respective dates, time and places reflected therein, and were signed by the proper school/hospital authorities
concerned.

__________________________ ______________________________________
Date Applicant’s Signature over printed name

Noted by:

SOFIA M. NATIVIDAD,RN,RM,MAN
Dean, College of Nursing

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