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    Application Form: Professional Regulation Commission

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    Rose Belle Villasana
    This document is an application form for the Certified Public Accountant examination to be taken by Selwyn Jay Villasana on May 21-23, 2023 in Tuguegarao. It provides his personal details including name, address, contact information, educational background from Cagayan State University where he obtained a Bachelor of Accountancy degree. It also lists the examination he is applying for, the date and location, and confirms he has not been convicted of any crimes. Upon approval, he will receive a Notice of Admission and Permanent Examination and Registration Record Card to sit for the examination.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form: Professional Regulation Commission

    Uploaded by

    Rose Belle Villasana
    6 views1 page
    This document is an application form for the Certified Public Accountant examination to be taken by Selwyn Jay Villasana on May 21-23, 2023 in Tuguegarao. It provides his personal details including name, address, contact information, educational background from Cagayan State University where he obtained a Bachelor of Accountancy degree. It also lists the examination he is applying for, the date and location, and confirms he has not been convicted of any crimes. Upon approval, he will receive a Notice of Admission and Permanent Examination and Registration Record Card to sit for the examination.

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    This document is an application form for the Certified Public Accountant examination to be taken by Selwyn Jay Villasana on May 21-23, 2023 in Tuguegarao. It provides his personal details including name, address, contact information, educational background from Cagayan State University where he obtained a Bachelor of Accountancy degree. It also lists the examination he is applying for, the date and location, and confirms he has not been convicted of any crimes. Upon approval, he will receive a Notice of Admission and Permanent Examination and Registration Record Card to sit for the examination.

    Copyright:

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

    Application Form: Professional Regulation Commission

    Uploaded by

    Rose Belle Villasana
    This document is an application form for the Certified Public Accountant examination to be taken by Selwyn Jay Villasana on May 21-23, 2023 in Tuguegarao. It provides his personal details including name, address, contact information, educational background from Cagayan State University where he obtained a Bachelor of Accountancy degree. It also lists the examination he is applying for, the date and location, and confirms he has not been convicted of any crimes. Upon approval, he will receive a Notice of Admission and Permanent Examination and Registration Record Card to sit for the examination.

    Copyright:

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

    APPOINTMENT DATE: Mar 31, 2023 (08:00 AM TO 09:00 AM) - PRC Tuguegarao

    Professional Regulation Commission

    APPLICATION FORM

    NOT FOR SALE (REPRODUCTION IS ALLOWED)


    REFERENCE NO: EXHGITQ2Q1VG
    Application No.
    OR: E2023-03-04560686 | AMOUNT: PHP 900.00
    023976
    X First Timer
    Repeater Name of Examination CERTIFIED PUBLIC ACCOUNTANT
    _________________________________
    Conditioned Date of Examination MAY 21 - 23, 2023
    _________________________________
    Absent
    Place of Examination Tuguegarao
    _________________________________
    ________________
    03/26/2023
    Date(mm/dd/yy)
    NOTICE: All supporting documents shall become part of the records of the Commission. All applications must be filed
    PERSONALLY by the applicant.

    PART I-PERSONAL INFORMATION


    SUR NAME GIVEN NAME/S MIDDLE NAME
    VILLASANA SELWYN JAY TABUNNOK
    Maiden Surname (for married female only)

    Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
    ZONE 1 ZONE 1 ROMA SUR ENRILE, CAGAYAN
    Gender Citizenship Contact numbers (Landline & Mobile) E-mail Address
    X Male Female X Filipino Others______ 09367651721 villasanaselwynjay@gmail.com
    Civil Status Date of Birth(mm/dd/yy) Place of Birth (City/Town,Prov) RURBAN Code(Town/City,Prov)
    X Single Married Widow/er 11/03/1999 PARACELIS, MT PROVINCE 014406
    Spouse’s name & Citizenship Father’s Name & Citizenship Mother’s Name & Citizenship
    SAMMY VILLASANA / FILIPINO JOROSE VILLASANA / FILIPINO
    HAVE YOU EVER BEEN CHARGED AND CONVICTED BY FINAL JUDGEMENT BY ANY COURT OF JUSTICE/MILITARY TRIBUNAL OR
    ADMINISTRATIVE BODY? X No Yes (If yes, attach hereto a copy of the decision)
    PART II – EDUCATIONAL INFORMATION
    Name of School Address/Location of School PRC School code
    CAGAYAN STATE UNIVERSITY-ANDREWS CAMPUS CARITAN, TUGUEGARAO CITY, CAGAYAN 2542
    Degree/Course Obtained PRC COURSE Code Date Graduated (mm/dd/yy) PRC Board Code
    BACHELOR IN ACCOUNTANCY 5087 07/05/2022 0100
    Date Graduated PRC SCHOOL
    Other Higher Educational Attainment Name of School Address/Location of School CODE
    (mm/dd/yy)

    PART III – PREVIOUS PRC LICENSURE EXAMINATION/S TAKEN (Last Three Exams)
    Place of Date Taken Result of Examination (pls check)
    Name of Examination Rating Exam No. Verified by
    Examination (mm/yy) Passed Failed Cond.

    Review School/Center: Self-Review School-Based Review Others (specify name) __________________________


    STATUS CODES (refer at the back) 1.) Examination Type (EXcode) 2.) Number of Times Taken 0

    I HEREBY CERTIFY that the information and/or ACTION TAKEN BY THE APPLICATION PROCESSOR
    statements in this application including the supporting ISSUANCE of the FOLOWING FORMS
    documents submitted in support thereof are all true and
    correct to my own knowledge, and that I am fully aware that NOTICE OF ADMISSION PERMANENT EXAMINATION &
    (NOA) REGISTRATION RECORD CARD (PERRC)
    any false information or statement in this application or in its
    attachments shall render me liable for criminal prosecution REMARKS ______________________________________________
    and/or administrative sanction. ______________________________________________________________________________

    PROCESSOR_____________________________ Date ___________


    RIGHT THUMBMARK _______________________ ____________________________________________________________
    Signature of Applicant ACTION TAKEN BY LEGAL OFFICER (if applicable)
    _______________________ REMARKS ______________________________________________
    Date Accomplished ______________________________________________________________________________

    LEGAL OFFICER __________________________ Date ___________


    Subscribed and sworn to before me this __________day of ____________________________________________________________
    _________20____at__________. Affiant applicant exhibited ACTION TAKEN BY THE BOARD
    to me his / her Community Tax Certificate No. APPROVED DISAPPROVED CONDITIONAL
    4651-8531-0790-3624
    ________________________issued PHILIPPINE STATISTIC AUTHORITY
    at _______________
    REMARKS ______________________________________________
    on _____________.
    05/10/2021 ______________________________________________________________________________
    DOCUMENTARY STAMP

    CHAIRMAN/ MEMBER ______________________ Date __________


    ____________________________________________________________
    ACTION TAKEN BY THE CASHIER
    _______________________________
    PRC ADMINISTERING OFFICER AMOUNT PAID ____________
    900.00 OFFICIAL RECEIPT NO.E2023-03-04560686
    _____________
    Paymaya - Gcash Payment
    CASHIER _________________________________ 03/26/2023
    Date __________
    ____________________________________________________________
    ACTION TAKEN BY THE ISSUING OFFICER
    Administration of Oath Is Free REMARKS _______________________________________________
    (Office Order No. 2009-377 & 2009-379 ______________________________________________________________________________
    both dated September 3, 2009)
    ISSUING OFFICER ________________________ Date __________

    IMPORTANT: FAILURE TO SUBMIT THIS APPLICATION FORM WITH THE REQUIRED DOCUMENTS SHALL MEAN APP-01
    NON-INCLUSION IN THE LIST OF EXAMINEES IN THE ROOM ASSIGNMENT AND FORFEITURE OF EXAMINATION FEES Rev. 00
    February 25, 2015
    Page 1 of 1

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