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    Professional Regulation Commission: (Reproduction Is Allowed

    Uploaded by

    Kentfhil Mae Aseron
    This document is an application for renewal of a Professional Identification Card (PIC) in the Philippines. It contains details such as the applicant's name, Filipino citizenship, birthdate, address, contact information, school and date graduated from, date of initial registration, expiration date, licensed profession, and a declaration signed by the applicant attesting that the information provided is true. It also contains notes about requirements for representatives applying on someone else's behalf and the importance of following the appointment date for PIC renewals.

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    Professional Regulation Commission: (Reproduction Is Allowed

    Uploaded by

    Kentfhil Mae Aseron
    38 views1 page
    This document is an application for renewal of a Professional Identification Card (PIC) in the Philippines. It contains details such as the applicant's name, Filipino citizenship, birthdate, address, contact information, school and date graduated from, date of initial registration, expiration date, licensed profession, and a declaration signed by the applicant attesting that the information provided is true. It also contains notes about requirements for representatives applying on someone else's behalf and the importance of following the appointment date for PIC renewals.

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    This document is an application for renewal of a Professional Identification Card (PIC) in the Philippines. It contains details such as the applicant's name, Filipino citizenship, birthdate, address, contact information, school and date graduated from, date of initial registration, expiration date, licensed profession, and a declaration signed by the applicant attesting that the information provided is true. It also contains notes about requirements for representatives applying on someone else's behalf and the importance of following the appointment date for PIC renewals.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    38 views1 page

    Professional Regulation Commission: (Reproduction Is Allowed

    Uploaded by

    Kentfhil Mae Aseron
    This document is an application for renewal of a Professional Identification Card (PIC) in the Philippines. It contains details such as the applicant's name, Filipino citizenship, birthdate, address, contact information, school and date graduated from, date of initial registration, expiration date, licensed profession, and a declaration signed by the applicant attesting that the information provided is true. It also contains notes about requirements for representatives applying on someone else's behalf and the importance of following the appointment date for PIC renewals.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    TIME RECEIVED:

    TIME RELEASED:

    Professional Regulation Commission

    APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD (PIC)

    NOT FOR SALE (REPRODUCTION IS ALLOWED)

    APPOINTMENT DATE: November 29, 2019 (11:00 AM TO 12:00 PM) - Philippine International Convention Center (PICC) (Renewal, Initial Reg, Applic for E
    REFERENCE NO: REF03YBHLYOS | OR: 930214263988 | Amount: PHP 450
    NAME: ASERON, FILIPINA RAMIREZ

    CITIZENSHIP: FILIPINO BIRTHDATE: December 20, 1971

    PERMANENT MAILING ADDRESS: MEZZA 2 RESIDENCES GUIRAYAN STREET AURORA BLVD BRGY DONA IMELDA
    TEL. NO. / CP NO.: +639564785354 / 0277570195 EMAIL ADDRESS: fias9206@gmail.com
    SCHOOL GRADUATED: DIVINE WORD COLLEGE OF CALAPAN DATE GRADUATED: March 29, 1994
    REGISTRATION DATE: February 03, 1998 EXPIRATION DATE: December 20, 2022
    PROFESSION: PROFESSIONAL TEACHER LICENSE NO.: 0293154

    DECLARATION AND ATTESTATION

    I am aware and I give my consent to the collection of the data required by this application form and
    the taking of my photograph, and if applicable, the taking of my fingerprints.

    I further attest that all particulars and supporting documents provided by me are correct and
    complete. I am aware that any false statement or fraudulent document will lead to the rejection of my
    application or to the cancellation of my PIC already issued, and may also render me liable under applicable
    administrative and criminal laws.

    SIGNATURE OF LICENSEE

    UNDERTAKING

    (To be filled up by professionals, except for Real Estate Practitioners, who failed to comply with the
    required CPD Credit Units for the renewal of Professional Identification Card)

    For this compliance period, I am submitting CPD units of the total required CPD Credit units. I
    hereby undertake to submit the balance of CPD credit units in addition to the required CPD units (or a
    total of units) for the next renewal of my PIC. I understand that in the event I fail to comply, my PIC will
    not be renewed.

    SIGNATURE OF LICENSEE

    NOTE:
    1) ALL REAL ESTATE PRACTITIONERS CANNOT AVAIL THE UNDERTAKING AND HAVE TO
    PROVIDE PROOF OF COMPLIANCE WITH CPD PRIOR TO RENEWAL OF PIC PURSUANT TO
    SECTION 17, ARTICLE III OF REPUBLIC ACT NO. 9646 OR THE REAL ESTATE SERVICE ACT
    OF THE PHILIPPINES AND BOARD RESOLUTION NO. 49, S. 2015.
    2) REPRESENTATIVE OF THE PROFESSIONAL APPLYING FOR ISSUANCE OF PROFESSIONAL
    IDENTIFICATION CARD (PIC) MUST SUBMIT:
    a) THE PRESCRIBED AUTHORIZATION LETTER AND PHOTOCOPY OF PROFESSIONAL
    IDENTIFICATION CARD (PIC) OF THE REPRESENTATIVE AND EXPIRED PIC OF THE
    PRFESSIONAL; OR
    b) SPECIAL POWER OF ATTORNEY (SPA) AND PHOTOCOPY OF ANY VALID GOVERNMENT
    ISSUED IDENTIFICATION CARD (ID) OF THE REPRESENTATIVE AND THE PROFESSIONAL
    3) STRICTLY FOLLOW THE APPOINTMENT DATE ON RENEWAL OF PROFESSIONAL
    IDENTIFICATION CARD (PIC).

    REG-03
    Rev. 02
    September 15, 2017
    Page 1 of 1

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