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PRC Form 104

This document is a Certificate of Experience form from the Philippines for an Electrical Engineering applicant named M____. It certifies the applicant's employment with a named company from specific date ranges where they held various positions and performed duties. The certifying officer must fill out and sign the form under oath before a notary to verify the applicant's work experience.

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Arafat Lomangcolob Baunto
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1K views1 page

PRC Form 104

This document is a Certificate of Experience form from the Philippines for an Electrical Engineering applicant named M____. It certifies the applicant's employment with a named company from specific date ranges where they held various positions and performed duties. The certifying officer must fill out and sign the form under oath before a notary to verify the applicant's work experience.

Uploaded by

Arafat Lomangcolob Baunto
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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PRC FORM NO.

104

NAME OF COMPANY/OFFICE

ADDRESS/E-MAIL/TELEPHONE NO./FAX NO.

CERTIFICATE OF EXPERIENCE
WARNING: All statements are subject to verification and any false statement or misrepresentation made in this CERTIFICATE is a ground for disqualification and criminal prosecution.
ELECTRICAL ENGINEERING (RME)
TO THE BOARD OF: _____________________________________________________________________
This is to certify that M_____________________________________________________________is/has been employed with the above-named office/company
located at ______________________________________________________________________ for the period and performed duties indicated below:

FROM TO POSITION HELD SPECIFIC WORK/FUNCTIONS

___________________________________________ SUBSCRIBED AND SWORN to before me this ________ day of


Affiant (Certifying Officer) _______________________________, 20 _______ at ______________________________________.
Affiant exhibited to me this Community Tax Certificate Number
(Signature above printed name)
__________________ issued at __________________________ on ________________________
Certificate of Registration No. ______________ issued on ________________________________

IMPORTANT: _________________________________
1. The certifying officer should be a registered professional of the same discipline Notary Public
whose date of registration is prior to the date of employment and PRC ID must be Doc. No. ______
valid. Page No. ______
2. This form is good only for one office/company. Book No. ______
3. Certificate of Employment must accompany this Certificate of Experience. Series of ______

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