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Panunumpa NG Propesyonal: Professional Regulation Commission
Panunumpa NG Propesyonal: Professional Regulation Commission
Panunumpa NG Propesyonal: Professional Regulation Commission
(Lagda)
PERSONAL DATA
Telephone/Contact Number: 09369277386 Date of Examination:Nov 2022
Citizenship: FILIPINO Date of Birth: Oct 29, 1999
Civil Status: SINGLE Sex: MALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: DENNIS BERNAL DEFIESTA / FILIPINO Mother’s Name/Citizenship: OLGA OLAYBAR LEONOR / FILIPINO
CONFORME
I agree to the PRC Privacy Notice and give my consent to the collection and processing of my personal data in
accordance thereto.
Signature of professional
Please present this slip at Issuance Window ___________________ to claim your Professional Identification Card on
_______________________.
(Registration Officer)
NOTE:
1. Please present the QR code upon entrance and exit of the oathtaking venue PRD-19
2. The QR code is non-transferable. Unauthorized use of the same shall be given appropriate sanction. Rev. 00
May 4, 2022
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