REFERENCE NO: CE6YYFOIZBMK | OR: E2022-10-02810906 | Amount: PHP 150.

00
Oct 06, 2022 (10:00 AM TO 11:00 AM) - PRC Dumaguete
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: Oct 05, 2022 Please underline: MALE/FEMALE

_______
NAME: GOLEZ, FLORENCE PURA
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: PROFESSIONAL TEACHER REGISTRATION NO.: - REGISTRATION DATE: -
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): TEL./CP NO.: 09386704454

PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:

CERTIFICATE OF REGISTRATION (COR) NO. OF COPIES PURPOSE:
X CERTIFICATION OF BOARD RATING NO. OF COPIES 2 LOCAL
CERTIFICATION OF GOOD STANDING NO. OF COPIES ABROAD
CERTIFICATION OF PASSING NO. OF COPIES LEGAL
PROFESSIONAL IDENTIFICATION CARD NO. OF COPIES STATEBOARD
REPORT OF RATINGS NO. OF COPIES OTHERS
OTHERS NO. OF COPIES

FOR PRC PROCESSING

150.00
Amount: ____________________________ Processed by: Prepared by:
_

E2022-10-02810906
O. R. No.: ___________________________
10/05/2022 ___________________________________ ____________________________________
Date: ___________________________
Signature over printed name Signature over printed name
PAYMAYA-GCASH
Issued by: ___________________________
- Date: ______________________________ Date: ________________________________
Date due: __________________________

NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.

AUTHENTICATION CLAIM SLIP

PLEASE FILL OUT THIS CLAIM SLIP

NAME: GOLEZ, FLORENCE PURA
_____________________________________ PROFESSION: PROFESSIONAL TEACHER
___________________________
-
REGISTRATION NO.: _____________________________________ -
REGISTRATION DATE: ___________________________
DATE FILED: Oct 05, 2022
_____________________________________ -
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 MAKE SURE THAT YOU HAVE THE ORIGINAL COPY OF

THE DOCUMENT/S TO BE AUTHENTICATED)

PRD-07
Rev. 00
October 16, 2020
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