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Panunumpa NG Propesyonal: Professional Regulation Commission
Panunumpa NG Propesyonal: Professional Regulation Commission
(Lagda)
PERSONAL DATA
Telephone/Contact Number: 09777894746 Date of Examination:Apr 2022
Citizenship: FILIPINO Date of Birth: Mar 03, 1999
Civil Status: SINGLE Sex: MALE Spouse’s Name/Citizenship:
Father’s Name/Citizenship: DARIO PAÑA CALAQUE / FILIPINO Mother’s Name/Citizenship: CATHERINE AYCO CALAQUE / FILIPINO
CONFORME
I agree to the PRC Privacy Notice and give my consent to the collection and processing of my personal data in
accordance thereto.
Signature of professional
Please present this slip at Issuance Window ___________________ to claim your Professional Identification Card on
_______________________.
(Registration Officer)
PRD-19
Rev. 00
May 4, 2022
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