PRC REG Form No. 001 (Rev. Nov.

2007)
Cellular Phone No. Republic of the Philippines
__________________
Professional Regulation Commission Paste here
Lucena City your recent
PASSPORT SIZE
colored picture in
plain white
background with
with complete
name tag (Last Name,
First Name, Middle
Name)

Ako si ___________________________________________________________________________ ng
_________________________________________________________________________________________
(Pook na sinilangan: Bayan/Lungsod, Probinsya)
ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na ako’y tunay
na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga atas na ipinahahayag
ng mga sadyang itinakdang kapangyarihan ng Republika ng Pilipinas; at kusa kong babalikatin ang
pananagutang ito, na walang ano mang pasubali o hangaring umiwas.
Taimtim pa rin akong nanunumpa na sa lahat ng panahon at pook na kinaroroonan ay mahigpit akong
manghahawakan sa mga etikal at tuntuning propesyonal ng mga ________________________________ sa
(Propesyon)
Pilipinas, at matapat kong gagampanan ng buong husay sa abot ng aking makakaya ang mga tungkulin at
pananagutang iniatang sa isang itinakdang _______________.
(Propesyon)
Kasiyahan Nawa Ako ng Diyos.
__________________________________
(Lagda)

A- ________________________ __________________________ _______________________

(Bilang ng Sedula) (Kinuha sa) (Petsa)

Nilagdaan at Pinanumpa sa harap ko ngayong ika _________ ng ______________________________

taon ng ating Panginoon _____________ sa _____________________________, Pilipinas.

POR PRC PROCESSING

OK to Pay: _______________________________
Selyo
OR No.: (Pinunong Tagapanumpa)
Date Paid:
Dokumentaryo
Profession:
Registration No: ____________________________
Registration Date: (Katungkulang Opisyal)

PERSONAL DATA
Date of Examination: Sex:
Citizenship: Date of Birth:
Civil Status: Spouse’ Name/Citizenship:
Father’s Name/Citizenship: Mother’s Name/Citizenship:

TEAR HERE
CLAIM SLIP (PRC-LUCENA) Serial # _______________

NAME:___________________________________________ PROFESSION:________________________
REGISTRATION / LICENSE NO.:_______________________ REG. DATE:__________________________
Present this slip to claim your professional ID after 3 to 4 months at Windows 1 & 2 (for various profession);
Windows 3, 4, 5 (for nurses); Windows 6, 7, 8 (for teachers)
(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 AND THIS ORIGINAL
CLAIM SLIP)
Note: Do not accept this stub without Serial Number
DUE DATE: ________________________
Please follow up after 3-4 months Registration Officer

(042) 373-7316 Date: _________________
 PROCEDURES
STEP 1 Accomplish this OATH FORM
STEP 2 Pay for metered documentary stamps at the Customer Service Center
STEP 3 Present duly accomplished Oath Form (where your profession belongs), for
verification of records and assessment at Windows 1, 2, 3, 4, 5, 6, 7, or 8
STEP 4 Pay the prescribed fees at the Cashier (Window 17)
STEP 5 Sign in the Registry Book, receive your claim slip.
STEP 6 Claim your professional ID as scheduled. Please refer to your claim slip for
further instructions.

REQUIREMENTS
1. Duly accomplished OATH FORM or PANUNUMPA ng PROPESYONAL
2. Current Community Tax Certificate (CEDULA)
3. Two (2) pieces passport size pictures with white background and complete name tag
(last name, first name, middle name) one (1) for the Oath Form & Certificate of
Registration)
4. One (1) piece 1x1 picture in plain white background with complete name tag (for
Registry of Professionals)
5. Two (2) sets of Metered Documentary Stamps for the Oath Form and Certificate of
Registration)
6. One (1) short brown envelope with name and profession

IMPORTANT
New registrants should come personally to the PRC Central Office or the nearest
Regional Office to file his/her application for registration and affix his/her signature on the
Registry Book.

Board Certificates shall be claimed by the licensee personally at the Central Office or
the Regional Office where the application for the same has been filed.

NOTE: ONLY REPRESENTATIVE with VALID PRC IDENTIFICATION and

SPECIAL POWER OF ATTORNEY will be issued the PROFESSIONAL
IDENTIFICATION CARD / CERTIFICATE OF REGISTRATION (as per
OFFICE ORDER 2003-164 dated October 07, 2003)