REFERENCE NO: CE7OR8AQVZ62 | OR: E2023-10-06394520 | Amount: PHP 75.

00
Oct 13, 2023 (04:00 PM TO 05:00 PM) - PRC Pagadian
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: Oct 12, 2023 Please underline: MALE/FEMALE

NAME: BANLASAN, GIVEHART MIRA
Last Name First Name Middle Name Married Name
PROFESSION:CRIMINOLOGIST REGISTRATION NO.: - REGISTRATION DATE: -
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): TEL./CP NO.: 09817142587

PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:

CERTIFICATE OF REGISTRATION (COR) NO. OF COPIES PURPOSE:
X CERTIFICATION OF BOARD RATING NO. OF COPIES 1 LOCAL
CERTIFICATION OF GOOD STANDING NO. OF COPIES 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

Amount: 75.00 Processed by: Prepared by:
. R. E2023-10-06394520
No.: Date: 10/12/2023
Signature over printed name Signature over printed name
PAYMAYA-GCASH
Issued Date: Date:
-
by: Date
due:

NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.

AUTHENTICATION CLAIM SLIP

PLEASE FILL OUT THIS CLAIM SLIP

NAME: BANLASAN, GIVEHART MIRA PROFESSION: CRIMINOLOGIST
___________________________
REGISTRATION NO.: - -
REGISTRATION DATE:
DATE FILED: Oct 12, 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

IMPORTANT NOTES:

1. PLEASE ENSURE THAT YOU BRING THE ORIGINAL DOCUMENT

YOU WISH TO HAVE AUTHENTICATED.
2. ADDITIONALLY, PLEASE REMEMBER TO BRING THE
CORRESPONDING NUMBER OF PHOTOCOPIES OF THE SAME
DOCUMENT THAT REQUIRE AUTHENTICATION.

PRD-07
Rev. 00
October 16, 2020
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