APPOINTMENT DATE: Oct 24, 2022 (12:00 PM TO 01:00 PM) - Robinsons Dasmariñas

REFERENCE NO: INK7UB6MVKZ7 | OR: E2022-10-02937103 (10/22/2022) | AMOUNT: PHP 1050.00

NOT FOR SALE (REPRODUCTION IS ALLOWED)

Republic of the Philippines

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

JOANNA MARIE DIMAILIG MUSTARD

Ako, si ______________________________________________________________________, ng
_____________________________________________________________________________________
BALAYAN, BATANGAS
(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
NURSE
____________________________ sa Pilipinas, at marapat kong gagampanan ng buong husay sa abot ng
(Propesyon)
aking makakaya ang mga tungkulin at pananagutang iniatang sa isang itinakdang
NURSE
________________________.
(Propesyon)

Kasihan Nawa ako ng Diyos.

______________________________________
( Lagda)
POLICE CLEARANCE
A - ____________________________ BALAYAN
_______________________ Jan 28, 2021
_________________________
(Blg. Ng Sedula) (Kinuha sa) (Petsa)

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

taon ng ating Panginoon _____________________ sa ___________________________, Pilipinas.

FOR PRC PROCESSING

1050.00
OK to Pay: __________________________________ __________________________________
Selyo E2022-10-02937103
OR No.: _____________________________________ (Pinunong Tagapanumpa)
Dokumentaryo Oct 22, 2022
Date Paid: ___________________________________
NURSE
Profession: __________________________________ __________________________________
Registration No.: ______________________________ (Katungkulang Opisyal)
Registration Date: _____________________________

PERSONAL DATA
Telephone/Contact Number: 09317912700 / 09263180696 Date of Examination: May 01, 2022
Citizenship: FILIPINO Date of Birth: May 23, 1993
Civil Status: MARRIED Sex: FEMALE Spouse’s Name/Citizenship: ALVIN MUSTARD / FILIPINO
Father’s Name/Citizenship: VICTOR DIMAILIG / FILIPINO Mother’s Name/Citizenship: MARCELINA DIMAILIG / FILIPINO

PLEASE FILL OUT THIS CLAIM SLIP

CLAIM SLIP

JOANNA MARIE DIMAILIG MUSTARD

NAME: _______________________________________ NURSE
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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