Scribd
Upload
111 views1 page

Professional Regulation Commission

This document contains an application for renewal of a Professional Identification Card (PIC) in the Philippines. It provides details of the applicant such as name, citizenship, address, contact information, education history, license number, and profession. It also includes declarations signed by the applicant regarding the accuracy of the information and consent to data collection. For those who did not meet continuing professional development requirements, an undertaking is included to submit outstanding credit units for the next renewal.

Uploaded by

rizza garcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
111 views1 page

Professional Regulation Commission

This document contains an application for renewal of a Professional Identification Card (PIC) in the Philippines. It provides details of the applicant such as name, citizenship, address, contact information, education history, license number, and profession. It also includes declarations signed by the applicant regarding the accuracy of the information and consent to data collection. For those who did not meet continuing professional development requirements, an undertaking is included to submit outstanding credit units for the next renewal.

Uploaded by

rizza garcia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

TIME RECEIVED:

TIME RELEASED:

Professional Regulation Commission

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD (PIC)

NOT FOR SALE (REPRODUCTION IS ALLOWED)

APPOINTMENT DATE: August 20, 2019 (05:00 PM TO 06:00 PM) - Robinsons Starmills
REFERENCE NO: RERKE8JMXZXT | OR: - | Amount: PHP -
NAME: LACAP, JOCELYN MAURICIO

CITIZENSHIP: FILIPINO BIRTHDATE: December 22, 1981

PERMANENT MAILING ADDRESS: CHAMPACA CADUANG TETE MACABEBE PAMPANGA


TEL. NO. / CP NO.: 09236519848 EMAIL ADDRESS: jocelynlacap@gmail.com
SCHOOL GRADUATED: BULACAN STATE UNIVERSITY (for.BCAT)-MALOLOS DATE GRADUATED: April 03, 2002
REGISTRATION DATE: November 12, 2002 EXPIRATION DATE: December 22, 2022
PROFESSION: PROFESSIONAL TEACHER LICENSE NO.: 0772842

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

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy