Oathtaking Date/Time: Dec 13, 2023 08:00 AM

Oathtaking Venue: PLENARY HALL, PICC, PASAY CITY

Republic of the Philippines

Professional Regulation Commission
Passport size
colored picture
with COMPLETE
PANUNUMPA NG PROPESYONAL Name Tag
in plain white
(Oath Form) background taken
within the last 3
months

EOEN0HCTB192
SANIELLE KARLA GARCIA LORENZO
Ako si ,ng
QUEZON CITY
(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, mgautos 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 ngmga 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)

(ID na inisyu ng gobyerno at bilang)

Nilagdaan at Pinanumpaan sa harap ko ngayong ika- ng
taon ng ating Panginoon sa , Pilipinas.

FOR PRC PROCESSING

Amount: __________________________________ __________________________________
Selyo OR No.: _____________________________________ (Pinunong Tagapanumpa)
Dokumentaryo
Date Paid: ___________________________________
Profession: __________________________________ __________________________________
Registration No.: ______________________________ (Katungkulang Opisyal)
Registration Date: _____________________________

PERSONAL DATA
Telephone/Contact Number: 09454921135 Date of Examination:Oct 2023
Citizenship: FILIPINO Date of Birth: Sep 11, 1992
Civil Status: MARRIED Sex: FEMALE Spouse’s Name/Citizenship: FRANCIS P PAPA / FILIPINO
Father’s Name/Citizenship: RUBEN V LORENZO / FILIPINO Mother’s Name/Citizenship: VILMA G LORENZO / 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 FILL OUT THIS CLAIM SLIP

CLAIM SLIP
SANIELLE KARLA GARCIA LORENZO
NAME: _______________________________________ PHYSICIAN
PROFESSION: _________________________________
REGISTRATION NO. ____________________________ REGISTRATION DATE: __________________________

Please present this slip at Issuance Window ___________________ to claim your Professional Identification Card on
_______________________.

(Registration Officer)

NOTE:
1. Please present the QR code upon entrance and exit of the oathtaking venue PRD-19
2. The QR code is non-transferable. Unauthorized use of the same shall be given appropriate sanction. Rev. 00
May 4, 2022
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