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    Opt Cos Fill Form 5555

    Uploaded by

    Annelyn Castillo
    This document is a petition form from a teacher in the Philippines to change her registered name due to marriage. It provides instructions on the requirements and procedures for submitting the petition. The form details the teacher's personal information including her maiden and married names, date of birth, registration number, and date of marriage. She certifies that the information provided is true and attaches a copy of her marriage certificate. The requirements section lists the documents needed including an original marriage certificate, photos, statutory and renewal fees, latest professional license, and CPE certificate if license is expired. The procedures explain the steps to submit the form, get documents verified and fees assessed, and submit the completed petition.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Opt Cos Fill Form 5555

    Uploaded by

    Annelyn Castillo
    31 views2 pages
    This document is a petition form from a teacher in the Philippines to change her registered name due to marriage. It provides instructions on the requirements and procedures for submitting the petition. The form details the teacher's personal information including her maiden and married names, date of birth, registration number, and date of marriage. She certifies that the information provided is true and attaches a copy of her marriage certificate. The requirements section lists the documents needed including an original marriage certificate, photos, statutory and renewal fees, latest professional license, and CPE certificate if license is expired. The procedures explain the steps to submit the form, get documents verified and fees assessed, and submit the completed petition.

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    opt_cos_fill_form_5555

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    This document is a petition form from a teacher in the Philippines to change her registered name due to marriage. It provides instructions on the requirements and procedures for submitting the petition. The form details the teacher's personal information including her maiden and married names, date of birth, registration number, and date of marriage. She certifies that the information provided is true and attaches a copy of her marriage certificate. The requirements section lists the documents needed including an original marriage certificate, photos, statutory and renewal fees, latest professional license, and CPE certificate if license is expired. The procedures explain the steps to submit the form, get documents verified and fees assessed, and submit the completed petition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views2 pages

    Opt Cos Fill Form 5555

    Uploaded by

    Annelyn Castillo
    This document is a petition form from a teacher in the Philippines to change her registered name due to marriage. It provides instructions on the requirements and procedures for submitting the petition. The form details the teacher's personal information including her maiden and married names, date of birth, registration number, and date of marriage. She certifies that the information provided is true and attaches a copy of her marriage certificate. The requirements section lists the documents needed including an original marriage certificate, photos, statutory and renewal fees, latest professional license, and CPE certificate if license is expired. The procedures explain the steps to submit the form, get documents verified and fees assessed, and submit the completed petition.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Republic of the Philippines

    Professional Regulation Commission Paste here


    Southern Tagalog Regional Office your recent
    Lucena City PASSPORT SIZE
    colored picture
    with full name tag
    in plain white
    Petition for change of registered name due to marriage background
    (Please see reverse side on Requirements and Procedures)

    I, _______________________________________________________________ of legal age, married, born


    on_____________________________________ at _______________________________________ and a resident of
    (date of birth) (place of birth)
    ______________________________________________________________, do hereby apply for change of name
    (permanent mailing address)
    from __________________________________________ to _______________________________________________
    (registered name) (married name)
    in the records of the Board for Professional Teachers and the Commission.

    I took and passed the examination given by the Board on ____________________________ and was
    (month and year)
    registered as Professional Teacher with Registration number ____________ dated _______________, and
    I got married to ____________________________________ at _________________________________________
    (husband’s name) (place of marriage)
    on ________________________.
    (date of marriage)

    (A copy of Marriage Contract/Certificate of Marriage is herewith attached as Annex “A”)


    I DO HEREBY CERTIFY that the foregoing date and those in the attached Marriage
    Contract/Certificate of Marriage are all true and correct of my own knowledge, and that may false
    declaration herein and the annex shall hold me liable for criminal/administrative prosecution.
    Date Accomplished Signature (Maiden Name) Signature (Married Name)

    Administering Officer

    METERED
    DOCUMENTARY
    Documentary
    S Stamp
    TAMP

    (1) REGISTRATION DO NOT FILL THIS PORTION (2 ) RECORDS SECTION


    DIVISION VERIFICATION
    Registered Name Name in the Master List

    Profession Exam Taken/Date/Rating | Resol/Date Approved

    PROFESSIONAL TEACHER
    Date of Birth Date of Birth Verified by:

    Registration No. Registration Date (3) CASH SECTION (Window 17)


    (payment of fees)
    Last Year Paid: (a) STATUTORY FEE:
    O.R No. _______________ Date ______________
    ________________________
    Amount Paid ______________________________
    Assessment of Fees: Verified by: (b) RENEWAL/DUPLICATE ID FEE
    ________________________ _______________ O.R No. _______________ Date ______________
    ________________________ _______________ Payment: _________________________________
    ________________________ _______________

    Screened by: __________________________ Received by: _____________________________


    (THIS FORM IS TO BE ACCOMPLISHED AND SIGNED BY THE
    PETITIONER HERSELF AND TO BE SUBMITTED IN ONE COPY)

    REQUIMENTS:
    1. Duly accomplished Petition Form.

    2. Original Marriage Certificate (issued by NSO in security paper)

    3. Three (3) copies of passport size picture in white background with complete name tag -
    (Last Name, First Name, Middle Name)

    4. Statutory Fee of PhP225.00 and Renewal Fee, as assessed, Duplicate ID Fee of PhP250.00 if ID
    is still current.

    5. Latest Professional License

    6. Original and Photocopy of Board rating (for verification)

    7. Certificate of CPE (seminar attended) for applicant with expired Professional License.

    PROCEDURES:
    1. Submit duly accomplished Petition Form and Marriage Contract (issued by NSO in security
    paper)

    2. Bring the documents to Registration Division for verification of registration and assessment of
    fees.

    3. Proceed to Records Section for verification of examination records.

    4. Proceed to the Cashier Section for payment of fees and;

    5. Go back to OPT Window (Window 7) to submit the Petition Form, Marriage Contract, Official
    Receipt of Payment and Picture.

    PRC-LUC
    /ate/rvc/rda/argagalac 8.14.12

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