APPOINTMENT DATE: Mar 04, 2021 (10:00 AM TO 11:00 AM) - PRC Zamboanga

REFERENCE NO: INTFFWV2VXQC | OR: 106202905307 (03/03/2021) | AMOUNT: PHP 1050

NOT FOR SALE (REPRODUCTION IS ALLOWED)

Republic of the Philippines

Professional Regulation Commission
Manila Paste here
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PANUNUMPA NG PROPESYONAL with complete
name tag

OMARIS ABON BAKIL

Ako, si ______________________________________________________________________, ng
_____________________________________________________________________________________
ISABELA, BASILAN
(Pook na Sinilangan, Bayan/Lungsod, Probinsya)
ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na ako ay
tunay na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga atas na
ipinahayag ng mga sadyang itinakdang may kapangyarihan ng Republika ng Pilipinas; at kusa kong
babalikatin ang pananagutang ito, na walang ano mang pasubali o hangaring umiwas.

Taimtim pa rin akong manunumpa na sa lahat ng panahon at pook na kinaroroonan ay mahigpit

akong manghahawakan sa mga etikal at tuntuning propesyonal ng mga
MEDICAL TECHNOLOGIST
____________________________ sa Pilipinas, at marapat kong gagampanan ng buong husay sa abot ng
(Propesyon)
aking makakaya ang mga tungkulin at pananagutang iniatang sa isang itinakdang
MEDICAL TECHNOLOGIST
________________________.
(Propesyon)

Kasihan Nawa ako ng Diyos.

______________________________________
( Lagda)
PRN M57190417833 P
A - ____________________________ ISABELA, BASILAN
_______________________ Sep 22, 2019
_________________________
(Blg. Ng Sedula) (Kinuha sa) (Petsa)

Nilagdaan at Pinanumpaan sa harap ko ngayong ika-____________ ng ________________________

taon ng ating Panginoon _____________________ sa ___________________________, Pilipinas.

FOR PRC PROCESSING

1050
OK to Pay: __________________________________ __________________________________
Selyo 106202905307
OR No.: _____________________________________ (Pinunong Tagapanumpa)
Dokumentaryo Mar 03, 2021
Date Paid: ___________________________________
MEDICAL TECHNOLOGIST
Profession: __________________________________ __________________________________
Registration No.: ______________________________ (Katungkulang Opisyal)
Registration Date: _____________________________

PERSONAL DATA
Telephone/Contact Number: 09974376432 Date of Examination: Jan 01, 2021
Citizenship: FILIPINO Date of Birth: Jan 12, 1998
Civil Status: SINGLE Sex: FEMALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: OTIS M. BAKIL / FILIPINO Mother’s Name/Citizenship: MARIA PILAR A. BAKIL / FILIPINO

PLEASE FILL OUT THIS CLAIM SLIP

CLAIM SLIP

OMARIS ABON BAKIL

NAME: _______________________________________ MEDICAL TECHNOLOGIST
PROFESSION: _________________________________
REGISTRATION NO. ____________________________ REGISTRATION DATE: __________________________
Please present this slip at Issuance Window ____________________ to claim your professional identification card on
________________________.
(NOTE: REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT SPECIAL POWER OF ATTORNEY/ AUTHORIZATION
LETTER FROM THE REGISTERED PROFESSIONAL). FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.

____________________________________________
(Registration Officer)

REG- 01
Rev. 00
February 25, 2015
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