REFERENCE NO: CEFOHWSR5UHK | OR: E2024-07-09022314 | Amount: PHP 75.
00
Jul 22, 2024 (04:00 PM TO 05:00 PM) - PRC Zamboanga
Professional Regulation Commission
STATEBOARD VERIFICATION SLIP
Jul 21, 2024
DATE FILED: _________________
NAME: ____________________________________________________________________________________________________________________________
TULO, LORILEE MAGALLANES
LAST NAME FIRST NAME MIDDLE NAME MARRIED NAME
NURSE
PROFESSION: __________________________________ 0480406
LICENSE NUMBER: ____________________ 04/22/2008
DATE OF REGISTRATION: ___________________________
(Month/Date/Year)
CITIZENSHIP:___________________________________
FILIPINO PROOF OF CITIZENSHIP: _____________________________________________ ___________________________
DATE/PLACE OF EXAMINATION: __________________________________________________________________________________________________________
EXAMINATION NUMBER: ___________________________ GENERAL AVERAGE: ________________ PRC ID CARD EXPIRATION DATE:______________________
03/19/2026
(Month/Date/Year)
TEL. /CELLPHONE NO./E-MAIL ADDRESS:_____________________________________________
+966505290971 / jayteedayrit@yahoo.com DATE OF BIRTH: ___________________________________
03/19/1986
(Month/Date/Year)
NAME OF SCHOOL: __________________________________________________________________________________________________________________________________
WESTERN MINDANAO STATE U-ZAMBOANGA CITY
(Complete Name)
SCHOOL ADDRESS: __________________________________________________________________________________________________________________________________
ZAMBOANGA CITY, ZAMBOANGA DEL SUR
(City/ Municipality/ Province)
BS IN NURSING
DEGREE COURSE: ______________________________________ Mar 27, 2007
DATE OF GRADUATION: ___________________________________________________________________
FOR PRC PROCESSING
ACTION TAKEN BY THE RECEIVER: _____________________ACTION TAKEN BY THE VERIFIER: _____________________O.R. NO.:____________________________
COURIER/IEMS: DESTINATION: ___________________________________DATE: _________ AMOUNT:__________________________________
NAME OF COURIER: _______________________________ ACTION TAKEN BY THE LEGAL AND INVESTIGATION DIVISION:
TRACKING NO.:______________________________________ CL NCL
DATE OF PICK-UP:____________________________________
ORDINARY/ REGISTERED MAIL
CONFORME:
I agree to the PRC Privacy Notice and give my consent to the collection and processing of my personal data in accordance thereto:
________________________________________________________________
LORILEE MAGALLANES TULO
Signature over printed name
ARD-10
/ Rev. 02
January 3, 2019
Page 1 of 2
Professional Regulation Commission
STATEBOARD VERIFICATION SLIP
Jul 21, 2024
DATE FILED: ____________________
NAME: ____________________________________________________________________________________________________________________________
TULO, LORILEE MAGALLANES
LAST NAME FIRST NAME MIDDLE NAME MARRIED NAME
PROFESSION: __________________________________
NURSE LICENSE NUMBER: ____________________
0480406 DATE OF REGISTRATION: ___________________________
04/22/2008
(Month/Date/Year)
CITIZENSHIP:___________________________________
FILIPINO PROOF OF CITIZENSHIP: ________________________________________________________________________
DATE/PLACE OF EXAMINATION: __________________________________________________________________________________________________________
EXAMINATION NUMBER: ___________________________ GENERAL AVERAGE: ________________ PRC ID CARD EXPIRATION DATE:______________________
03/19/2026
(Month/Date/Year)
TEL. /CELLPHONE NO./E-MAIL ADDRESS:_____________________________________________
+966505290971 / jayteedayrit@yahoo.com DATE OF BIRTH: __________________________________
03/19/1986
(Month/Date/Year)
NAME OF SCHOOL: __________________________________________________________________________________________________________________________________
WESTERN MINDANAO STATE U-ZAMBOANGA CITY
(Complete Name)
SCHOOL ADDRESS: _________________________________________________________________________________________________________________________________
ZAMBOANGA CITY, ZAMBOANGA DEL SUR
(City/ Municipality/ Province)
BS IN NURSING
DEGREE COURSE: ________________________________________________ Mar 27, 2007
DATE OF GRADUATION: ___________________________________________________________
FOR PRC PROCESSING
ACTION TAKEN BY THE RECEIVER: _____________________ACTION TAKEN BY THE VERIFIER: _____________________O.R. NO.:_______________________
COURIER/IEMS: DESTINATION: _____________________________________DATE: _____ ______ ___ AMOUNT: ___________________________
NAME OF COURIER: _______________________________ ACTION TAKEN BY THE LEGAL AND INVESTIGATION DIVISION:
TRACKING NO.:______________________________________ CL NCL
DATE OF PICK-UP:____________________________________
ORDINARY/ REGISTERED MAIL
CONFORME:
I agree to the PRC Privacy Notice and give my consent to the collection and processing of my personal data in accordance thereto:
LORILEE MAGALLANES TULO
_______________________________________________________________________
Signature over printed name
ARD-10
Rev. 02
January 3, 2019
NOTE: Please make sure that you have the original copy of the document/s to be authenticated. Page 1 of 2
