REFERENCE NO: CEJ90F9G9P2S | OR: E2022-12-03293809 | Amount: PHP 150.

00
Dec 21, 2022 (11:00 AM TO 12:00 PM) - National Capital Region - Morayta (Certificate of passing and rating)
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: Dec 18, 2022 Please underline: MALE/FEMALE

_______
NAME: VILLASANA, JANET FLORENO
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: PROFESSIONAL TEACHER REGISTRATION NO.: 0137152 REGISTRATION DATE: 09/16/1997
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 03/23/2024 TEL./CP NO.: 09959631781

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

FOR PRC PROCESSING

150.00
Amount: ____________________________ Processed by: Prepared by:
_

E2022-12-03293809
O. R. No.: ___________________________
12/18/2022 ___________________________________ ____________________________________
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: VILLASANA, JANET FLORENO
_____________________________________ PROFESSION: PROFESSIONAL TEACHER
___________________________
0137152
REGISTRATION NO.: _____________________________________ 09/16/1997
REGISTRATION DATE: ___________________________
DATE FILED: Dec 18, 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
Page 1 of 2