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04 002 PRC Renewal Form

This document outlines the procedures for renewing or replacing a professional identification card from the Professional Regulation Commission of the Philippines. It provides instructions on completing an application form, submitting requirements like photos and copies of licenses, paying fees at the cashier, and claiming the identification card at specified windows and dates according to the claim slip. Proper identification is needed if sending a representative to claim the card.

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Joy Agnez Bangalisan-Gramata
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© Attribution Non-Commercial (BY-NC)
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1K views2 pages

04 002 PRC Renewal Form

This document outlines the procedures for renewing or replacing a professional identification card from the Professional Regulation Commission of the Philippines. It provides instructions on completing an application form, submitting requirements like photos and copies of licenses, paying fees at the cashier, and claiming the identification card at specified windows and dates according to the claim slip. Proper identification is needed if sending a representative to claim the card.

Uploaded by

Joy Agnez Bangalisan-Gramata
Copyright
© Attribution Non-Commercial (BY-NC)
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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TO BE ACCOMPLISHED PERSONALLY BY THE PROFESSIONAL

Republic of the Philippines Professional Regulation Commission Manila

PRC REG Form No. 003 (Rev.Sept.2004)

RENEWAL DUPLICATE REPRINT CHANGE OF NAME NAME:


Last Name

REGISTRATION DIVISION APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD


,
First Name Middle Name

Paste here Your recent PASSPORT SIZE Colored picture in White background with complete name tag

PERMANENT MAILING ADDRESS: DATE FILED:


(mm/dd/yy)

PROFESSION: LICENSE NO.


(mm/dd/yy)

EXAM DATE:
(mm/dd/yy)

REGISTRATION DATE: CITIZENSHIP:

EXPIRATION DATE:
(mm/dd/yy)

BIRTH DATE:
(mm/dd/yy)

TEL. No./CP No.: _________________________________


SIGNATURE OF LICENSEE FOR PRC PROCESSING

This is to certify that all the information above are true and correct.

YLP FROM: ______________ TO: ______________ P/ ______________ SURCHARGE: ______________ TOTAL AMOUNT: ______________ VERIFIED AND ASSESSED BY: ________________________________

Amount: _______________________ Date:__________________________

O.R.No.: ______________________ Issued by: _____________________

PLEASE FILL OUT THIS CLAIM SLIP ISSUED BY:______________________________________


NAME: PROFESSION: LICENSE NO.: APPLICATION TYPE: RENEWAL DUPLICATE

ID CLAIM SLIP
DATE FILED: ______________________________________
AMOUNT: OR NO. DATE PAID: REPRINT CHANGE OF NAME

Please present this slip to claim your professional ID on ______________________________ at Window ____________________________________ (NOTE: REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT SPECIAL POWER OF ATTORNEY/AUTHORIZATION LETTER FROM THE PREGISTERED PROFESSIONAL AND THIS ORIGINAL CLAIM SLIP.) FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.

PROCEDURES

Step 1: Step 2: Step 3: Step 4:

Present duly accomplished form together with the requirements at Assessment Windows Window 16 Window 18 Window 30 Pay prescribed fees at the Cashier Get your claim slip at Windows 16, 18 and 30 Claim your professional license as scheduled. Please refer to your claim slip for further instructions.

REQUIREMENTS 1. 2. 3. 4. 5. Duly accomplished form Two (2) pcs passport size picture: close up, colored, white background with complete name tag Photo/xerox copy of recent professional ID card In case of LOST professional ID card which is still current, the applicant shall submit notarized Affidavit of Loss In case of DESTROYED professional ID card, the applicant shall surrender the destroyed card

NOTE: As the authorized representative, I assume direct and full responsibility/liability for the security of the professional ID. __________________________________
Signature over Printed Name of REPRESENTATIVE

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