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    Renewal Form - Re28kq5gacas

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    joef26816
    Sample renewal form

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

    Renewal Form - Re28kq5gacas

    Uploaded by

    joef26816
    3 views2 pages
    Sample renewal form

    Original Title

    RENEWAL FORM - RE28KQ5GACAS(1)

    Copyright

    © © All Rights Reserved

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    Sample renewal form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3 views2 pages

    Renewal Form - Re28kq5gacas

    Uploaded by

    joef26816
    Sample renewal form

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    REFERENCE NO: RE28KQ5GACAS | APPOINTMENT DATE: November 14, 2024 - 09:00 AM-10:00 AM

    Professional Regulation Commission


    APPLICATION FOR RENEWAL OF PROFESSIONAL
    IDENTIFICATION CARD (PIC)

    APPOINTMENT DATE: November 14, 2024 - 09:00 AM-10:00 AM O.R. NO. / DATE: E2024-11-09892816 - November 12, 2024
    PLACE: Robinsons Iloilo TEL NO./CP NO.: 09307793983
    LAST NAME: GABUTIN FIRST NAME: JOSE FRANCIS
    MIDDLE NAME: SOURIBIO MAIDEN NAME (if married): N/A
    PROFESSION: MECHANICAL ENGINEER LICENSE NO: 0100416
    REGISTRATION DATE: April 06, 2018 EXPIRATION DATE: October 04, 2027
    CITIZENSHIP: FILIPINO CIVIL STATUS: SINGLE
    BIRTHDATE: October 04, 1989 EMAIL ADDRESS: joef26816@gmail.com
    PERMANENT MAILING ADDRESS: N/A N/A SALVACION
    CURRENT EMPLOYER (if employed): PROVINCIAL OFFICE ADDRESS: SAN MIGUEL JORDAN GUIMARAS
    GOVERNMENT OF GUIMARAS
    CONFORME:

    I agree to the PRC Privacy Notice and give my consent to the collection and processing of my personal data in accordance thereto.

    JOSE FRANCIS SOURIBIO GABUTIN


    (SIGNATURE OVER PRINTED NAME)

    CPD UNDERTAKING:

    I hereby undertake to comply with the CPD requirements in the next compliance period.

    SIGNATURE OF LICENSEE

    Basic Requirements:
    1. Proof of system generated signed application form for the renewal of Professional Identification Card (PIC).
    2. Certificate of attendance to accredited Continuing Professional Development (CPD) seminars (Annex A) validated through the CPD
    Accreditation System (CPDAS), otherwise sign CPD Undertaking.
    3. Other documents as may be prescribed by the Professional Regulatory Law of the concerned profession i.e. Certificate of Good
    Standing, Surety Bond for Real Estate.

    Additional Requirements:
    1. For Overseas Filipino Professionals (OFPs), in lieu of CPD Certificates shall submit any of the following:.
    a. Overseas Employment Certificate (OEC) from Philippine Overseas Employment Administration (POEA);
    b. Passport and working visa or permit (in a foreign country);
    c. Contract of Service or Employment Overseas;
    d. Company Identification Card (foreign company);
    e. Residence permit/permit to stay in a foreign country; or
    f. Other credible proof/s of identity or status as OFP
    2. A former Filipino professional who has reacquired Philippine citizenship shall submit the following:
    a. Certificate of Reacquisition/Retention of Philippine Citizenship (CRPC) issued by the Bureau of Immigration (BI); and
    b. Copy of new Oath Form (Panunumpa ng Propesyonal)
    3. For professionals with dual citizenship, shall submit any of the following:
    a. Proof of Philippine citizenship (i.e. valid Philippine passport);
    b. Oath of Allegiance from Philippine Consulate and Identification Certificate of Philippine Citizenship issued by the Bureau of
    Immigration; and
    c. Certificate of Retention or Re-acquisition issued by Bureau of Immigration

    Requirements for Representative:


    1. Non-registered professional - any valid government-issued ID and Special Power of Attorney (SPA) duly executed individually by the
    applicant.

    PRD-27
    Rev. 02
    February 15, 2024
    Page 1 of 2
    2. Registered professional - valid Professional Identification Card/e-PIC and authorization letter duly signed by the concerned applicant.

    Procedures:
    1. Log in using LERIS account https://online.prc.gov.ph to secure an appointment date and place, and select payment option/channel. If
    the client opts for the delivery of printed PRC PIC, select shipping button, input shipping details and select payment options. .
    2. Present the proof of system-generated Application Form for the Renewal of PIC and other documentary requirements to the
    designated window.
    3. Receive the valid PIC and sign on the releasing log sheet.

    PRD-27
    Rev. 02
    February 15, 2024
    Page 2 of 2
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