REFERENCE NO: CEDQJBT2HWAW | OR: E2022-10-02846045 | Amount: PHP 75.

00
Oct 11, 2022 (04:00 PM TO 05:00 PM) - Robinsons Place Tagum
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 10, 2022 Please underline:_____

MALE/FEMALE
NAME: SANTOS, BENJAMIN JR LAURON
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: AGRICULTURAL AND BIOSYSTEMS ENGINEER
REGISTRATION NO.: 0003938 REGISTRATION DATE: 10/14/1996
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 11/11/2025 TEL./CP NO.: 0848230910 / 09069684239

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 1 STATEBOARD
REPORT OF RATINGS NO. OF COPIES OTHERS
OTHERS NO. OF COPIES

FOR PRC PROCESSING

75.00
Amount: ____________________________ Processed by: Prepared by:
_

E2022-10-02846045
O. R. No.: ___________________________
10/10/2022 ___________________________________ ____________________________________
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: SANTOS, BENJAMIN JR LAURON
_____________________________________ PROFESSION: AGRICULTURAL AND BIOSYSTEMS ENGINEER
___________________________
0003938
REGISTRATION NO.: _____________________________________ 10/14/1996
REGISTRATION DATE: ___________________________
DATE FILED: Oct 10, 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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