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Application Form: Professional Regulation Commission

Sherwin Natino has applied to take the November 2023 Civil Engineer licensure examination. He graduated with a BS in Civil Engineering from Camarines Norte State College-Daet in June 2020. This will be his first time taking the exam. His application was approved and he paid the PHP 900 fee on October 10, 2023. He will sit for the exam on November 17-18, 2023 at the examination site in Legazpi City.

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Sherwin Natino
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37 views1 page

Application Form: Professional Regulation Commission

Sherwin Natino has applied to take the November 2023 Civil Engineer licensure examination. He graduated with a BS in Civil Engineering from Camarines Norte State College-Daet in June 2020. This will be his first time taking the exam. His application was approved and he paid the PHP 900 fee on October 10, 2023. He will sit for the exam on November 17-18, 2023 at the examination site in Legazpi City.

Uploaded by

Sherwin Natino
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
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APPOINTMENT DATE: Oct 18, 2023 (10:00 AM TO 11:00 AM) - PRC Legazpi

Professional Regulation Commission

APPLICATION FORM

NOT FOR SALE (REPRODUCTION IS ALLOWED)


REFERENCE NO: EXZJRI5RL09T
Application No.
OR: E2023-10-06380773 | AMOUNT: PHP 900.00
085322
X First Timer
Repeater Name of Examination CIVIL ENGINEER
_________________________________
Conditioned Date of Examination NOVEMBER 17 - 18, 2023
_________________________________
Absent
Place of Examination Legazpi
_________________________________
________________
10/10/2023
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
NATINO SHERWIN
Maiden Surname (for married female only)

Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
N/A P-6 ALAYAO CAPALONGA, CAMARINES NORTE
Gender Citizenship Contact numbers (Landline & Mobile) E-mail Address
X Male Female X Filipino Others______ 09519754816 sherwintrey35@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 09/22/1995 JOSE PANGANIBAN, CAMARINES NORTE 051605
Spouse’s name & Citizenship Father’s Name & Citizenship Mother’s Name & Citizenship
MERLYN RONOLO NATINO / 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
CAMARINES NORTE STATE COLLEGE-DAET DAET, CAMARINES NORTE 1174
Degree/Course Obtained PRC COURSE Code Date Graduated (mm/dd/yy) PRC Board Code
BS IN CIVIL ENGINEERING 3044 06/18/2020 0600
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
6340-7859-7083-6015
________________________issued CAPALONGA CAMARINES NORTE
at _______________
REMARKS ______________________________________________
on _____________.
08/11/2022 ______________________________________________________________________________
DOCUMENTARY STAMP

CHAIRMAN/ MEMBER ______________________ Date __________


____________________________________________________________
ACTION TAKEN BY THE CASHIER
_______________________________
PRC ADMINISTERING OFFICER AMOUNT PAID ____________
900.00 OFFICIAL RECEIPT NO.E2023-10-06380773
_____________
Paymaya - Gcash Payment
CASHIER _________________________________ 10/10/2023
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
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