REFERENCE NO: CE0RIX3SM438 | OR: E2023-01-03464004 | Amount: PHP 75.
00
Jan 05, 2023 (01:00 PM TO 02:00 PM) - PRC Davao
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 03, 2023 Please underline: MALE/FEMALE
_______
NAME: FLORES, JHOVELLE MARTINEZ
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: CIVIL ENGINEER REGISTRATION NO.: - REGISTRATION DATE: -
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)
VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): TEL./CP NO.: 09516864433
PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:
CERTIFICATE OF REGISTRATION (COR) NO. OF COPIES PURPOSE:
CERTIFICATION OF BOARD RATING NO. OF COPIES LOCAL
CERTIFICATION OF GOOD STANDING NO. OF COPIES ABROAD
X CERTIFICATION OF PASSING NO. OF COPIES 1 LEGAL
PROFESSIONAL IDENTIFICATION CARD NO. OF COPIES STATEBOARD
REPORT OF RATINGS NO. OF COPIES OTHERS
OTHERS NO. OF COPIES
FOR PRC PROCESSING
75.00
Amount: ____________________________ Processed by: Prepared by:
_
E2023-01-03464004
O. R. No.: ___________________________
01/03/2023 ___________________________________ ____________________________________
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: FLORES, JHOVELLE MARTINEZ
_____________________________________ PROFESSION: CIVIL ENGINEER
___________________________
-
REGISTRATION NO.: _____________________________________ -
REGISTRATION DATE: ___________________________
DATE FILED: Jan 03, 2023
_____________________________________ -
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 MAKE SURE THAT YOU HAVE THE ORIGINAL COPY OF
THE DOCUMENT/S TO BE AUTHENTICATED)
PRD-07
Rev. 00
October 16, 2020
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