REFERENCE NO: CECGMXDBMW6C | OR: E2023-02-04125040 | Amount: PHP 225.

00
Feb 22, 2023 (08:00 AM TO 09:00 AM) - PRC Tacloban
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: Feb 20, 2023 Please underline:_____

MALE/FEMALE
NAME: GENISTON, SHERDAN GALES
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: PROFESSIONAL TEACHER REGISTRATION NO.: 1926985 REGISTRATION DATE: 06/15/2022
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 04/07/2025 TEL./CP NO.: 09106673781 / 09106673781

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
X CERTIFICATION OF GOOD STANDING NO. OF COPIES 3 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

225.00
Amount: ____________________________ Processed by: Prepared by:
_

E2023-02-04125040
O. R. No.: ___________________________
02/20/2023 ___________________________________ ____________________________________
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: GENISTON, SHERDAN GALES
_____________________________________ PROFESSION: PROFESSIONAL TEACHER
___________________________
1926985
REGISTRATION NO.: _____________________________________ 06/15/2022
REGISTRATION DATE: ___________________________
DATE FILED: Feb 20, 2023
_____________________________________ -
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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