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Teachers Renewal Form

This document contains an application form for a professional identification card from the Professional Regulation Commission of the Philippines for teachers. The form requests the applicant's personal information like name, address, date of birth, contact details, citizenship, profession, exam and registration details. It certifies the information provided and notes that the identification card can be claimed after 4-6 months by presenting the claim slip at the specified office window. It also contains instructions for representatives to claim the card along with a sample picture ID layout.

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rotsacrreijav123
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226 views1 page

Teachers Renewal Form

This document contains an application form for a professional identification card from the Professional Regulation Commission of the Philippines for teachers. The form requests the applicant's personal information like name, address, date of birth, contact details, citizenship, profession, exam and registration details. It certifies the information provided and notes that the identification card can be claimed after 4-6 months by presenting the claim slip at the specified office window. It also contains instructions for representatives to claim the card along with a sample picture ID layout.

Uploaded by

rotsacrreijav123
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Republic of the Philippines

Professional Regulation Commission


Lucena City

OFFICE FOR PROFESSIONAL TEACHERS

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD



Last Name First Name Middle Name
PERMANENT MAILING ADDDRESS:
DATE FILED: PROFESSION: TEACHER EXAM DATE:
REGISTRATION DATE: LICENSE / REGISTRATION NO: EXPIRATION DATE:
(mm/dd/yyyy)
CITIZENSHIP: BIRTH DATE: CONTACT NO:
(mm/dd/yyyy)
This is to certify that the above information are true and correct
Signature of Licensee
FOR PRC PROCESSING

YLP FROM: TO: P AMOUNT: O.R. NO.:
SURCHARGE:
TOTAL AMOUNT: DATE: ISSUED BY:
VERIFIED AND ASSESSED BY:

PRC-LUCENA CLAIM SLIP (to be filled up by the applicant)
ISSUED BY: __________________________________________ DATE FILED: _________________________
NAME: DATE OF BIRTH:

AMOUNT:
PROFESSION: (Secondary) (Elementary) TEACHER

OR NO.:
REGISTRATION NO.: REGISTRATION DATE:

DATE PAID:
APPLICATION TYPE: RENEWAL DUPLICATE REPRINT CHANGE OF NAME
Please present this slip to claim your professional ID after 4 to 6 months / 4 to 8 months for Change of Status/Change of Name at Window 6.
(NOTE: REPRESENTATIVE WITH VALID ID SHOULD PRESENT SPECIAL POWER OF ATTORNEY FROM THE REGISTERED PROFESSIONAL
AND THIS ORIGINAL CLAIM SLIP. PROFESSIONAL WITH UPDATED PRC ID WHO IS ACTING AS REPRESENTATIVE MAY ONLY PRESENT
AUTHORIZATION LETTER AND HIS/HER ID.) (042) 373-7316

Republic of the Philippines
Professional Regulation Commission
Lucena City

OFFICE FOR PROFESSIONAL TEACHERS

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD



Last Name First Name Middle Name
PERMANENT MAILING ADDDRESS:
DATE FILED: PROFESSION: TEACHER EXAM DATE:
REGISTRATION DATE: LICENSE / REGISTRATION NO: EXPIRATION DATE:
(mm/dd/yyyy)
CITIZENSHIP: BIRTH DATE: CONTACT NO:
(mm/dd/yyyy)
This is to certify that the above information are true and correct
Signature of Licensee
FOR PRC PROCESSING

YLP FROM: TO: P AMOUNT: O.R. NO.:
SURCHARGE:
TOTAL AMOUNT: DATE: ISSUED BY:
VERIFIED AND ASSESSED BY:

PRC-LUCENA CLAIM SLIP (to be filled up by the applicant)
ISSUED BY: __________________________________________ DATE FILED: _________________________
NAME: DATE OF BIRTH:

AMOUNT:
PROFESSION: (Secondary) (Elementary) TEACHER

OR NO.:
REGISTRATION NO.: REGISTRATION DATE:

DATE PAID:
APPLICATION TYPE: RENEWAL DUPLICATE REPRINT CHANGE OF NAME
Please present this slip to claim your professional ID after 4 to 6 months / 4 to 8 months for Change of Status/Change of Name at Window 6.
(NOTE: REPRESENTATIVE WITH VALID ID SHOULD PRESENT SPECIAL POWER OF ATTORNEY FROM THE REGISTERED PROFESSIONAL
AND THIS ORIGINAL CLAIM SLIP. PROFESSIONAL WITH UPDATED PRC ID WHO IS ACTING AS REPRESENTATIVE MAY ONLY PRESENT
AUTHORIZATION LETTER AND HIS/HER ID.) (042) 373-7316

Paste here
your recent
PASSPORT SIZE
colored picture with
complete name tag in
plain white background

PRC REG Form No. 003 (Rev. 01/2006
TO BE ACCOMPLISHED
PERSONALLY BY THE
PROFESSIONAL
RENEWAL
DUPLICATE
REPRINT
CHANGE OF NAME
PLS. PRINT LEGIBLY


Paste here
your recent
PASSPORT SIZE
colored picture with
complete name tag in
plain white background

PRC REG Form No. 003 (Rev. 01/2006
TO BE ACCOMPLISHED
PERSONALLY BY THE
PROFESSIONAL
RENEWAL
DUPLICATE
REPRINT
CHANGE OF NAME
PLS. PRINT LEGIBLY

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