REFERENCE NO: CE2LRBJVPPU8 | OR: E2022-09-02671825 | Amount: PHP 150.
00
Sep 20, 2022 (11:00 AM TO 12:00 PM) - PRC Zamboanga
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: Sep 19, 2022 Please underline:_____
MALE/FEMALE
NAME: PAÑA, JESSIERICK EMOTIN
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: PROFESSIONAL TEACHER REGISTRATION NO.: 1541967 REGISTRATION DATE: 06/08/2017
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)
VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 12/25/2025 TEL./CP NO.: 09661445527
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:
_
E2022-09-02671825
O. R. No.: ___________________________
09/19/2022 ___________________________________ ____________________________________
Date: ___________________________
Signature over printed name Signature over printed name
PAYMAYA-GCASH
Issued by: ___________________________
- Date: ______________________________ Date: ________________________________
Date due: __________________________
NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.
AUTHENTICATION CLAIM SLIP
PLEASE FILL OUT THIS CLAIM SLIP
NAME: PAÑA, JESSIERICK EMOTIN
_____________________________________ PROFESSION: PROFESSIONAL TEACHER
___________________________
1541967
REGISTRATION NO.: _____________________________________ 06/08/2017
REGISTRATION DATE: ___________________________
DATE FILED: Sep 19, 2022
_____________________________________ -
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
(PLEASE MAKE SURE THAT YOU HAVE THE ORIGINAL COPY OF
THE DOCUMENT/S TO BE AUTHENTICATED)
PRD-07
Rev. 00
October 16, 2020
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