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    Claim Slip Authenticate

    Uploaded by

    laucsap0896
    Claim slip authenticate for PRC

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

    Claim Slip Authenticate

    Uploaded by

    laucsap0896
    7 views1 page
    Claim slip authenticate for PRC

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    claim slip authenticate

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    Claim slip authenticate for PRC

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views1 page

    Claim Slip Authenticate

    Uploaded by

    laucsap0896
    Claim slip authenticate for PRC

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    REFERENCE NO: CE73TO8Z2C03 | OR: 20220113121212800110170375817939126 | Amount: PHP 300.

    00
    Jan 18, 2022 (01:00 PM TO 02:00 PM) - PRC Baguio
    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: Jan 13, 2022 Please underline:_____


    MALE/FEMALE
    NAME: PASCUAL, MARK JHON RIENO UBILAS
    _____________________________________________________________________________________________
    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.: 09355534749 / 09355534749

    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 4 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


    300.00
    Amount: ____________________________ Processed by: Prepared by:
    _

    20220113121212800110170375817939126
    O. R. No.: ___________________________
    01/13/2022 ___________________________________ ____________________________________
    Date: ___________________________
    Signature over printed name Signature over printed name
    PAYMAYA-GCASH
    Issued by: ___________________________
    - Date: ______________________________ Date: ________________________________
    Date due: __________________________

    NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.

    AUTHENTICATION CLAIM SLIP

    PLEASE FILL OUT THIS CLAIM SLIP


    NAME: PASCUAL, MARK JHON RIENO UBILAS
    _____________________________________ PROFESSION: CRIMINOLOGIST
    ___________________________
    -
    REGISTRATION NO.: _____________________________________ -
    REGISTRATION DATE: ___________________________
    DATE FILED: Jan 13, 2022
    _____________________________________ -
    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

    PLEASE SEE THE REQUIREMENTS AND PROCEDURES AT THE BACK OF THIS SHEET

    PRD-07
    Rev. 00
    October 16, 2020
    Page 1 of 2

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