APPOINTMENT DATE: Dec 03, 2020 (02:00 PM TO 3:00PM) - Robinsons Place Ilocos Norte

REFERENCE NO: INA9PRV71P6E | OR: 033312951435 (11/28/2020) | AMOUNT: PHP 1050

NOT FOR SALE (REPRODUCTION IS ALLOWED)

Republic of the Philippines

Professional Regulation Commission
Manila Paste here
your recent
PASSPORT SIZE
colored picture in
white background
PANUNUMPA NG PROPESYONAL with complete
name tag

KNEDRICK KEVIN CACUT MACALMA

Ako, si ______________________________________________________________________, ng
_____________________________________________________________________________________
SAMPALOC, MANILA
(Pook na Sinilangan, Bayan/Lungsod, Probinsya)
ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na ako ay
tunay na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga atas na
ipinahayag ng mga sadyang itinakdang may kapangyarihan ng Republika ng Pilipinas; at kusa kong
babalikatin ang pananagutang ito, na walang ano mang pasubali o hangaring umiwas.

Taimtim pa rin akong manunumpa na sa lahat ng panahon at pook na kinaroroonan ay mahigpit

akong manghahawakan sa mga etikal at tuntuning propesyonal ng mga
PHYSICIAN
____________________________ sa Pilipinas, at marapat kong gagampanan ng buong husay sa abot ng
(Propesyon)
aking makakaya ang mga tungkulin at pananagutang iniatang sa isang itinakdang
PHYSICIAN
________________________.
(Propesyon)

Kasihan Nawa ako ng Diyos.

______________________________________
( Lagda)
0768724
A - ____________________________ PRC MOBILE ILOCOS NORTE _________________________
_______________________ Aug 25, 2012
(Blg. Ng Sedula) (Kinuha sa) (Petsa)

Nilagdaan at Pinanumpaan sa harap ko ngayong ika-____________ ng ________________________

taon ng ating Panginoon _____________________ sa ___________________________, Pilipinas.

FOR PRC PROCESSING

1050
OK to Pay: __________________________________ __________________________________
Selyo 033312951435
OR No.: _____________________________________ (Pinunong Tagapanumpa)
Dokumentaryo Nov 28, 2020
Date Paid: ___________________________________
PHYSICIAN
Profession: __________________________________ __________________________________
Registration No.: ______________________________ (Katungkulang Opisyal)
Registration Date: _____________________________

PERSONAL DATA
Telephone/Contact Number: +639771700100 Date of Examination: Nov 01, 2020
Citizenship: FILIPINO Date of Birth: Aug 29, 1991
Civil Status: SINGLE Sex: MALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: OSCAR BARAOED MACALMA / FILIPINOMother’s Name/Citizenship: AGNES RAQUEL CACUT MACALMA / FILIPINO

PLEASE FILL OUT THIS CLAIM SLIP

CLAIM SLIP

KNEDRICK KEVIN CACUT MACALMA

NAME: _______________________________________ PHYSICIAN
PROFESSION: _________________________________
REGISTRATION NO. ____________________________ REGISTRATION DATE: __________________________
Please present this slip at Issuance Window ____________________ to claim your professional identification card on
________________________.
(NOTE: REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT SPECIAL POWER OF ATTORNEY/ AUTHORIZATION
LETTER FROM THE REGISTERED PROFESSIONAL). FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.

____________________________________________
(Registration Officer)

REG- 01
Rev. 00
February 25, 2015
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