Republic of the Pbilippines: PRC REC FORM 991-4) ‘Drolessional Aearienon Commission merece le ed RECORDS MANAGEMENT DIVISION nrcisrnarton pare ‘ACTION SHEET cn omancaten Sonoma cexnmseavon NAME (USED AT THE TIME OF EXAM); heen | are rite: DATE OF RELEASE: Il = — a ae = same oF boano exam Tae Ta DATE OF EXAM: a copy) v0, oF cor: err 1 Board Rating Underage Othere’ resin rove Re IS poe Eten a ree lever: ClecewenraeyCJoeconoawy [EJ pcan — EJenmgeamnmm TOR FAC PROUHTERT 1 DATE FILED: 4 ee caincaron ssc rmnrne meen eg ee PROFESSION: a Tae = ae nao ey a ous Number of Copies: Répount Pad: a ——— Piste rovent ihe sip to cam documents n__f REPRESENTATIVE WITH PROPER IDENTIFICATION iz | oe ne os fat ASTON ETER NOVAS Woman AFTER CLAIMING THE REQUESTED ORIGINAL CERTIFICATIONS, PLEASE PROCE! /STOMER | Se i ie ame oneness CERTIFICATION/AUTHENTICATION OF LICENSURE EXAMINATION RESULTS (Goard Rating, Passing, Placer, Underage, Without Examination) Step 1. Accomplish this Action Sheet (AS). Step 2. Pay certification/authentication fee (P75.00 / copy) at the Cashier (Main Building). NOTE: For Authiontidation of documents, kindly have your photo'xerox copylies bear tvith motered documentary stamp at. ‘Se i step 3. Progent gly accomplished AS together with the requirements at Window K. Get your Claim Slip, Step 4 On duc date; present your Claim Slip at Window E and receive documents, REQUIREMENTS - 4, Duly accomplished Action Sheet. 2. PRG Onficial Receipt. & Foc authentication, original and photo/xerox copies of documents to be authenticated, 3S BRotwiterox copy of valid professional license and claim stub in case PRC 1.D. was Tenewed and under process. NOTE: Original Certifications not claimed within two (2) months from the date of scheduled felease shall be disposed of. ‘Authentications with attached original documents not claimed within six (6) months from date of fling shall be disposed.