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REFERENCE NO: CE0PTNH6HCQ7 | OR: E2025-02-11057432 | Amount: PHP 300.

00
Feb 24, 2025 (08:00 AM TO 09:00 AM) - PRC Legazpi
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: Feb 21, 2025 Please underline: MALE/FEMALE


_______
NAME: AWAYAN, ROSALIE OPSIMA N/A
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: PROFESSIONAL TEACHER REGISTRATION NO.: 2133123 REGISTRATION DATE: 01/23/2024
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 11/17/2027 TEL./CP NO.: 09297515106

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
X CERTIFICATION OF GOOD STANDING NO. OF COPIES 4 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:
_

E2025-02-11057432
O. R. No.: ___________________________
02/21/2025 ___________________________________ ____________________________________
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: AWAYAN, ROSALIE OPSIMA
_____________________________________ PROFESSION: PROFESSIONAL TEACHER
___________________________
2133123
REGISTRATION NO.: _____________________________________ 01/23/2024
REGISTRATION DATE: ___________________________
DATE FILED: Feb 21, 2025
_____________________________________ -
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

IMPORTANT NOTES:

1. PLEASE ENSURE THAT YOU BRING THE ORIGINAL DOCUMENT YOU


WISH TO HAVE AUTHENTICATED.
2. ADDITIONALLY, PLEASE REMEMBER TO BRING THE CORRESPONDING
NUMBER OF PHOTOCOPIES OF THE SAME DOCUMENT THAT REQUIRE
AUTHENTICATION.

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

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