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NOTE
Please print your Application Form, Renewal Form, Oath Form, Order of Payment
or Action Sheet before proceeding to your preferred Appointment Place /

Oathtaking Venue (If for Oathtaking).

FOR LANDBANK PAYMENTS - Pending payment will be synced within 2-3 days. If

your payment has not been validated within 3 days, please contact LANDBANK to
avoid double/multiple payments.

REFERENCE NO.
DETAILS
ACTIONS

CETWS5TXS9YI
:
 Status of Payment: PAID

Payment Option: PAYMAYA-GCASH

Amount: 75.00

Application: Certi<cation

Profession: MEDICAL TECHNOLOGIST

×
License No.: 0111987

Transact Date: February 29, 2024 3:20 PM

REFERENCE NO: CETWS5TXS9YI | OR: E2024-02-07727479 | Amount: PHP 75.00
Mar 04, 2024 (01:00 PM TO 02:00 PM) - PRC-Bohol
NOTE: This appointment date might beDate:
Payment different to the date of claiming
February 29, 2024of the
3:57requested
PM authenticated documents
Professional Regulation Commission

Appointment Place: ACTIONSHEETFORAUTHENTICATION

ACTION SHEET FOR AUTHENTICATION
PRC-Bohol

DATE FILED: Feb 29, 2024

_____
NAME: Appointment Date: MarchRODINI
04, 2024 - 01:00 PM TO 02:00 PM
_____________________________________________________________________________________________
CELLAN, ROSS ESTILLORE
Last Name First Name Middle Name
PROFESSION: MEDICAL TECHNOLOGIST REGISTRATION NO.: 0111987 05/22/2023
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 09/24/2026 09451499132

PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:

X CERTIFICATE OF REGISTRATION (COR) 
PAYMENT DETAILS 1
NO. OF COPIES
CERTIFICATION OF BOARD RATING NO. OF COPIES
CERTIFICATION OF GOOD STANDING NO. OF COPIES
CERTIFICATION OF PASSING
PROFESSIONAL IDENTIFICATION CARD 
PRINT
NO.DOCUMENT
OF COPIES
NO. OF COPIES
REPORT OF RATINGS NO. OF COPIES
OTHERS NO. OF COPIES
 PRINT EOR
FOR PRC PROCESSING
75.00
Amount: ____________________________ Processed by:
_

E2024-02-07727479
O. R. No.: ___________________________
02/29/2024 ___________________________________
Date: ___________________________
Signature over printed name
PAYMAYA-GCASH
Issued by: ___________________________
- Date: ______________________________
Date due: __________________________

NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.

INGPNQ5QDAN4
AUTHENTICATIONCLAIMSLIP
AUTHENTICATION CLAIM SLIP

PLEASE FILL OUT THIS CLAIM SLIP

NAME: Status
CELLAN,ofROSS
Payment: PAID
RODINI ESTILLORE
_____________________________________ PROFESSION: MEDICAL TECHNOLOGIST
0111987
REGISTRATION NO.: _____________________________________ REGISTRATION DATE 05/22/2023
DATE FILED: Feb 29, 2024
_____________________________________ DATE DUE: -
Payment Option: PAYMAYA-GCASH
PLEASE PRESENT THIS SLIP TO CLAIM DOCUMENTS AT ______________ ON
REPRESENTATIVE SHOULD PRESENT ANY VALID GOVERNMENT-ISSUED ID AND AUTHORIZATION LETTER; IF NOT REGISTERED
PROFESSIONAL, PRESENT SPECIALAmount: 1050.00
POWER OF ATTORNEY(SPA)AND ANY VALID GOVE

Application: Initial Registration

Profession: MEDICAL TECHNOLOGIST

IMPORTANTNOTES:
IMPORTANT NOTES:
Applic No.:
:
 IMPORTANTNOTES:
IMPORTANT NOTES:
Applic No.: 022180

1.PLEASEENSURETHATYOUBRINGTHEORIGINAL
1. PLEASE ENSURE THAT YOU BRING THE ORIGINAL DOCUMENT YOU
WISHTOHAVEAUTHENTICATED.
Transact Date: May 19, 2023 3:03 PM
WISH TO HAVE AUTHENTICATED.

EUMAERO
2.
MALYLESFAE
SEMEN
SAM
R YOR
ADDITIONALLY, PLEASE REMEMBER TO BRING THE CORRESPONDING
Payment Date: May 19, 2023 3:10 PM

Appointment Place: PRC-Bohol

Appointment Date: May 22, 2023 - 08:00 AM TO 09:00 AM

 PAYMENT DETAILS

 PRINT OATH FORM

 PRINT EOR
 VIEW e-PIC

CLOSE

EOQ2RH0L0SCK

Application: Face to Face Mass Oath Taking

Transact Date: April 13, 2023 6:04 PM

Profession: MEDICAL TECHNOLOGIST

Applic No.: 022180

Regional Oace: PRC Cebu - Main OUce (Initial Registration, PIC Renewal, Certi<cations)

E-Oath Date: Apr 30, 2023 - 02:00 pm

Status: ATTENDED

 OATH DETAILS
:
  PRINT OATH FORM

EXWGP9DTX2IX

Status of Payment: PAID

Payment Option: PAYMAYA-GCASH

Amount: 900.00

Application: Exam Application (Local)

Applic Type.: Exam Application (Local)

Applic No.: 022180

Examination Name: MEDICAL TECHNOLOGIST

Examination Type: Complete/First-timer

Examination Place: Cebu

Examination Date: MARCH 8 - 9, 2023

Transact Date: January 28, 2023 4:58 PM

Payment Date: January 28, 2023 5:03 PM

Appointment Place: PRC Cebu - Robinsons (Exam Application only)

Appointment Date: January 31, 2023 - 11:00 AM TO 12:00 PM

 PAYMENT DETAILS

 PRINT APPLIC FORM

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