APPOINTMENT DATE: Jun 30, 2022 (09:00 AM TO 10:00 AM) - My Metro Town Mall

REFERENCE NO: INPCGUF0BQ29 | OR: E2022-06-01792450 (06/04/2022) | AMOUNT: PHP 1050.00

NOT FOR SALE (REPRODUCTION IS ALLOWED)

Republic of the Philippines

Professional Regulation Commission
Manila Paste here
your recent
PASSPORT SIZE
colored picture in
white background
PANUNUMPA NG PROPESYONAL with complete
name tag

ROMER DELA CRUZ ZULUETA

Ako, si ______________________________________________________________________, ng
_____________________________________________________________________________________
LINGAYEN, PANGASINAN
(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
CIVIL ENGINEER
____________________________ sa Pilipinas, at marapat kong gagampanan ng buong husay sa abot ng
(Propesyon)
aking makakaya ang mga tungkulin at pananagutang iniatang sa isang itinakdang
CIVIL ENGINEER
________________________.
(Propesyon)

Kasihan Nawa ako ng Diyos.

______________________________________
( Lagda)
Z430KRXR89-MT403675 NBI BRANCH
A - ____________________________ METRO TOWN MALL-TARLAC
_______________________ Jan 15, 2021
_________________________
(Blg. Ng Sedula) (Kinuha sa) (Petsa)

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

taon ng ating Panginoon _____________________ sa ___________________________, Pilipinas.

FOR PRC PROCESSING

1050.00
OK to Pay: __________________________________ __________________________________
Selyo E2022-06-01792450
OR No.: _____________________________________ (Pinunong Tagapanumpa)
Dokumentaryo Jun 04, 2022
Date Paid: ___________________________________
CIVIL ENGINEER
Profession: __________________________________ __________________________________
Registration No.: ______________________________ (Katungkulang Opisyal)
Registration Date: _____________________________

PERSONAL DATA
Telephone/Contact Number: 09568069326 Date of Examination: May 01, 2022
Citizenship: FILIPINO Date of Birth: Nov 23, 1998
Civil Status: SINGLE Sex: MALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: ROLANDO F. ZULUETA / FILIPINO Mother’s Name/Citizenship: MERLY D. ZULUETA / FILIPINO

PLEASE FILL OUT THIS CLAIM SLIP

CLAIM SLIP

ROMER DELA CRUZ ZULUETA

NAME: _______________________________________ CIVIL ENGINEER
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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