Please Make Sure That You Have The Original Copy of The Document/S To Be Authenticated

This document is an action sheet from the Professional Regulation Commission (PRC) regarding the authentication of documents for Maricris Tubig Lerit. It details that Ms. Lerit needs two copies of her Professional Identification Card authenticated and has an appointment on April 5, 2021 from 3-4 PM at the PRC office in San Fernando, Pampanga. The document lists her registration information as a nurse, registration number, and validity of her professional ID card. It provides instructions on claiming the authenticated documents with proper identification.

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Please Make Sure That You Have The Original Copy of The Document/S To Be Authenticated

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maricris lerit

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REFERENCE NO: CEF2J3IB7NPQ | OR: 109008991573 | Amount: PHP 150.

00
Apr 05, 2021 (03:00 PM TO 4:00PM) - PRC San Fernando
NOTE: This appointment date might be different to the date of claiming of the requested authenticated documents
Professional Regulation Commission
ACTION SHEET FOR AUTHENTICATION

DATE FILED: Mar 31, 2021 Please underline: MALE/FEMALE

_______
NAME: LERIT, MARICRIS TUBIG
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: NURSE REGISTRATION NO.: 0841421 REGISTRATION DATE: 08/04/2014
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)

VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 12/24/2023 TEL./CP NO.: 09168395407

PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:

CERTIFICATE OF REGISTRATION (COR) NO. OF COPIES PURPOSE:
CERTIFICATION OF BOARD RATING NO. OF COPIES LOCAL
CERTIFICATION OF GOOD STANDING NO. OF COPIES ABROAD
CERTIFICATION OF PASSING NO. OF COPIES LEGAL
X PROFESSIONAL IDENTIFICATION CARD NO. OF COPIES 2 STATEBOARD
REPORT OF RATINGS NO. OF COPIES OTHERS
OTHERS NO. OF COPIES

FOR PRC PROCESSING

150.00
Amount: ____________________________ Processed by: Prepared by:
_

109008991573
O. R. No.: ___________________________
03/31/2021 ___________________________________ ____________________________________
Date: ___________________________
Signature over printed name Signature over printed name
PAYMAYA-VISA
Issued by: ___________________________
- Date: ______________________________ Date: ________________________________
Date due: __________________________

NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.

AUTHENTICATION CLAIM SLIP

PLEASE FILL OUT THIS CLAIM SLIP

NAME: LERIT, MARICRIS TUBIG
_____________________________________ PROFESSION: NURSE
___________________________
0841421
REGISTRATION NO.: _____________________________________ 08/04/2014
REGISTRATION DATE: ___________________________
DATE FILED: Mar 31, 2021
_____________________________________ -
DATE DUE: _____________________________________

PLEASE PRESENT THIS SLIP TO CLAIM DOCUMENTS AT ______________ ON ______________________. PRC REGISTERED
REPRESENTATIVE SHOULD PRESENT ANY VALID GOVERNMENT-ISSUED ID AND AUTHORIZATION LETTER; IF NOT REGISTERED
PROFESSIONAL, PRESENT SPECIAL POWER OF ATTORNEY(SPA)AND ANY VALID GOVERNMENT-ISSUED ID.

REGISTRATION OFFICER