REFERENCE NO: CEIBGUKD3R94 | OR: 113411960196 | Amount: PHP 225.

00
May 18, 2021 (11:00 AM TO 12:00 PM) - Robinsons Place Ormoc
NOTE: This appointment date might be different to the date of claiming of the requested authenticated documents
Professional Regulation Commission
ACTION SHEET FOR AUTHENTICATION

DATE FILED: May 14, 2021 Please underline: MALE/FEMALE

_______
NAME: LAMBIT, LHEE ANN GONZALES
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: PROFESSIONAL TEACHER REGISTRATION NO.: 1253854 REGISTRATION DATE: 12/16/2013
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 08/16/2023 TEL./CP NO.: 09095354720

PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:

CERTIFICATE OF REGISTRATION (COR) NO. OF COPIES PURPOSE:
CERTIFICATION OF BOARD RATING NO. OF COPIES LOCAL
CERTIFICATION OF GOOD STANDING NO. OF COPIES ABROAD
CERTIFICATION OF PASSING NO. OF COPIES LEGAL
X PROFESSIONAL IDENTIFICATION CARD NO. OF COPIES 3 STATEBOARD
REPORT OF RATINGS NO. OF COPIES OTHERS
OTHERS NO. OF COPIES

FOR PRC PROCESSING

225.00
Amount: ____________________________ Processed by: Prepared by:
_

113411960196
O. R. No.: ___________________________
05/14/2021 ___________________________________ ____________________________________
Date: ___________________________
Signature over printed name Signature over printed name
PAYMAYA-WALLET
Issued by: ___________________________
- Date: ______________________________ Date: ________________________________
Date due: __________________________

NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.

AUTHENTICATION CLAIM SLIP

PLEASE FILL OUT THIS CLAIM SLIP

NAME: LAMBIT, LHEE ANN GONZALES
_____________________________________ PROFESSION: PROFESSIONAL TEACHER
___________________________
1253854
REGISTRATION NO.: _____________________________________ 12/16/2013
REGISTRATION DATE: ___________________________
DATE FILED: May 14, 2021
_____________________________________ -
DATE DUE: _____________________________________

PLEASE PRESENT THIS SLIP TO CLAIM DOCUMENTS AT ______________ ON ______________________. PRC REGISTERED
REPRESENTATIVE SHOULD PRESENT ANY VALID GOVERNMENT-ISSUED ID AND AUTHORIZATION LETTER; IF NOT REGISTERED
PROFESSIONAL, PRESENT SPECIAL POWER OF ATTORNEY(SPA)AND ANY VALID GOVERNMENT-ISSUED ID.

REGISTRATION OFFICER

PLEASE SEE THE REQUIREMENTS AND PROCEDURES AT THE BACK OF THIS SHEET

PRD-07
Rev. 00
October 16, 2020
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