Professional Documents
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MAITA
MAITA
EOINBDOCX5L6
SUZZIE MAITA AMOR JUAGPAO GOMA
Ako si ,ng
CARMEN, SURIGAO DEL SUR
(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, mgautos 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.
(Lagda)
PERSONAL DATA
Telephone/Contact Number: 09631204124 Date of Examination:Sep 2023
Citizenship: FILIPINO Date of Birth: Sep 24, 1998
Civil Status: SINGLE Sex: FEMALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: DANTE C. GOMA / FILIPINO Mother’s Name/Citizenship: SHIELA J. GOMA / 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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