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Department of Transportation and Communications
PUNONGHIMPILAN TANOD A!A!IN NG PILIPINAS
"Head#uarters P$i%ippine Coast Guard&
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Street, Port Area
'-'. Mani%a
APPLICATION /ORM
PCG ENLISTMENT0COMMISSIONSHIP
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Contro% Nr1
Coast Guard Officer Course 2 Commissions$ip Coast Guards Man Course 2 En%istment
Last Name Gi3en Name Midd%e Name

Permanent Address Re4ion

irt$date irt$ P%ace Re%i4ion 5ip Code

Contact Num6er "Ce%%p$one 0
Land%ine& Se7 A4e Ci3i% Status Hei4$t 8ei4$t

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/at$er9s Name A4e Occupation Li3in40Deceased

Mot$er9s Name A4e Occupation Li3in40Deceased

Parent9s Mai%in4 Address Contact Num6er

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Le3e% Name of Sc$oo%
Inc%usi3e !ears Honors0A:ards
Recei3ed
Genera%
A3era4e
/rom To
Hi4$ Sc$oo%

;ocationa%
Course<

Co%%e4e
Course<

I $ere6= certif= t$at t$e a6o3e information are true and correct
App%icant9s Si4nature E7amination Date 0 Time Inter3ie:er9s Si4nature

----------------------------------------------------------------------------------------------------------------------------------
E7amination Permit
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
"Last Name& "/irst Name& "Midd%e Name&
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>>>>
"P%ace of E7am& "Date of E7am&
Initia% Re#uirements<
1. Transcript of Records/List of Grades authenticated by School (Xerox)
2. olle!e "iplo#a / ertificate fro# School (Xerox)
$. %irth ertificate (Xerox)
&. 2x2 'icture (2 pcs)
Note<
(o re)uire#ents / *nco#plete re)uire#ents + NO E?AM
Important Reminders<
1. ,xa#inees #ust brin! exa#ination per#it-
blac. ballpen / pencil on exa#ination proper.
2. 0pplicants #ust be in casual attire and in proper
haircut.
$. alculator / cellphone are not allo1ed durin! exa#.