Professional Documents
Culture Documents
(Lagda)
PERSONAL DATA
Telephone/Contact Number: 09161194944 Date of Examination:Oct 2022
Citizenship: FILIPINO Date of Birth: Apr 12, 1980
Civil Status: SINGLE Sex: MALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: JOVITO DOMINGO / FILIPINO Mother’s Name/Citizenship: ANTHONITA DOMINGO / 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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