RENEWAL DUPLICATE

CHANGE OF NAME/STATUS

Republic of the Philippines Professional Regulation Commission Baguio City

PRC REG Form No. 003 (Rev. 4/11/12)

REPRINT

REGULATIONS DIVISION
_,
First Name Middle Name

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD (PIC)

Paste here recent PASSPORT SIZE colored picture with complete name tag in white background

PERMANENT ADDRESS: DATE FILED: _ REGISTRATION DATE:

_ _
PROFESSION: _ REGISTRATION NO: BIRTH DATE:

ZIP CODE: EXAM DATE: _

_ _
(mm/dd/yy)

(mm/dd/yy)

EXPIRATION DATE: _
(VALID UNTIL) (mm/dd/yy)

CITIZENSHIP:

_
(mm/dd/yy)

E-MAIL/CELL NO./TEL NO.

This is to certify that all the information above are true and correct.
SIGNATURE OF LICENSEE
FOR PRC PROCESSING

YLP FROM:

TO: SURCHARGE: TOTAL AMOUNT:

P Amount: Date: OR No: Issued by:

ASSESSED BY: ID CLAIM SLIP

PLEASE FILL THIS PORTION NAME: PROFESSION: REGISTRATION NO.: APPLICATION TYPE:

ORIGINAL ID

ISSUED BY: AMOUNT PAID: OFFICIAL RECEIPT NO.: DATE PAID: DUPLICATE REPRINT

Date

CHANGE OF NAME

Renewal applications are transmitted to CENTRAL OFFICE-MANILA 2-3 days from receipt and processing of PIC is done at CENTRAL OFFICE in 4-6 months. To check if your PIC is ready for release, visit our WEBSITE www.prcbaguio.blogspot.com for PIC availability (PICAV) or TEXT 09219693919 (Smart) or EMAIL us at [email protected]. To claim your PIC, present this slip at window 9. For a representative, present this claim slip, valid ID and authorization letter from the Professional. See also our schedule of mobile processing in your City/Town at our WEBSITE www.prcbaguio.blogspot.com.

RENEWAL DUPLICATE
CHANGE OF NAME/STATUS

Republic of the Philippines Professional Regulation Commission Baguio City

PRC REG Form No. 003 (Rev. 4/11/12)

REPRINT

REGULATIONS DIVISION
_,
First Name

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD (PIC)

_ _ _

_
Middle Name

Paste here recent PASSPORT SIZE colored picture with complete name tag in white background

PERMANENT ADDRESS: DATE FILED: _ REGISTRATION DATE:

ZIP CODE: EXAM DATE: _

_
(mm/dd/yy)

_
(mm/dd/yy)

PROFESSION: _ REGISTRATION NO: BIRTH DATE:

EXPIRATION DATE: _
(VALID UNTIL) (mm/dd/yy)

CITIZENSHIP:

_
(mm/dd/yy)

E-MAIL/CELL NO./TEL NO.

This is to certify that all the information above are true and correct.
SIGNATURE OF LICENSEE
FOR PRC PROCESSING

YLP FROM:

TO: SURCHARGE: TOTAL AMOUNT:

P Amount: Date: OR No: Issued by:

ASSESSED BY: ID CLAIM SLIP

PLEASE FILL THIS PORTION NAME: PROFESSION: REGISTRATION NO.: APPLICATION TYPE:

ORIGINAL ID

ISSUED BY: AMOUNT PAID: OFFICIAL RECEIPT NO.: DATE PAID: DUPLICATE REPRINT

Date

CHANGE OF NAME

Renewal applications are transmitted to CENTRAL OFFICE-MANILA 2-3 days from receipt and processing of PIC is done at CENTRAL OFFICE in 4-6 months. To check if your PIC is ready for release, visit our WEBSITE www.prcbaguio.blogspot.com for PIC availability (PICAV) or TEXT 09219693919 (Smart) or EMAIL us at [email protected]. To claim your PIC, present this slip at window 9. For a representative, present this claim slip, valid ID and authorization letter from the Professional. See also our schedule of Mobile processing in your City/Town at our WEBSITE www.prcbaguio.blogspot.com.

REQUIREMENTS 1. Duly accomplished Form. 2. Two (2) pieces RECENT passport-size colored picture in white background with complete nametag. 3. One photocopy of latest Professional Identification Card. 4. In case of loss of unexpired Professional Identification Card, submit duly notarized Affidavit of Loss. 5. Marriage certificate from NSO (in security paper) for married female applicants who wish to apply for change of name due to marriage. ADDITIONAL REQUIREMENT AS PRESCRIBED BY RESPECTIVE BOARDS

a. ARCHITECTS - UAP MEMBERSHIP ID/CERTIFICATION OF GOOD STANDING b. CUSTOMS BROKER CERTIFICATION OF GOOD STANDING FROM CCBI c. ELECTRONICS ENGR/PROF. ELECTRONICS ENGR./ELECTRONICS TECHNICIAN -IECEP CERTIFICATION OF GOOD
STANDING

d. GEODETIC ENGINEER. - G.E.P. MEMBERSHIP ID/CERTIFICATION OF GOOD STANDING e. GUIDANCE AND COUNSELING VALID CERTIFICATE OF PGCA MEMBERSHIP AND ANNUAL PAYMENT RECEIPTS f. MECHANICAL ENGR/PROF. MECHANICAL ENGR/CERTIFIED PLANT MECHANIC CERTIFICATION OF GOOD STANDING g. h.
FROM PHILIPPINE SOCIETY OF MECHANICAL ENGINEERS holding office at Don Lorenzo Bldg., P. Paredes St., Sampaloc, Manila and its duly accredited regional chapters PROF. AGRI. ENGRS. FILL-UP DATA FORM AND SUBMIT PSAE ID/CERTIFICATION OF GOOD STANDING REGISTERED ELECTRICAL ENGRS./RME/PEE - IIEE MEMBERSHIP ID/CERTIFICATION OF GOOD STANDING PROCEDURES

Step 1 - Get renewal form from the Public Assistance and Complaints Desk (for married female applicants, get also petition form for change
of name due to marriage).

Step 2 - Accomplish renewal/petition form and paste passport-size colored picture in white background with complete nametag. Step 3 - Proceed to Renewal Section (Window 7 or 8) and present your accomplished renewal/petition form and Professional Identification
Card for assessment of fees and evaluation of requirements.

Step 4 - Pay the renewal fees at Cashier (Window 5 or 6 located at the back entrance). Step 5 - Proceed to Renewal Section (Window 7 or 8) and submit renewal/petition form, official receipt, photocopy of

Professional Identification Card, and 1 passport-size picture, and original NSO marriage certificate (for married female applicants only). Receive your claim slip from the registration officer.

Note: To claim ID, present this Claim Slip at Window 9. Representative claiming the ID must present Authorization Letter from the Professional, Valid ID and Claim Slip.

As the authorized representative, I assume direct and full responsibility/liability for the professional ID card released to me. Attached is my authorization signed by the licensee.
________________________________________________________________

Signature over Printed Name of REPRESENTATIVE

REQUIREMENTS

1. 2. 3. 4. 5.

Duly accomplished Form. Two (2) pieces RECENT passport-size colored picture in white background with complete nametag. One photocopy of latest Professional Identification Card. In case of loss of unexpired Professional Identification Card, submit duly notarized Affidavit of Loss. Marriage certificate from NSO (in security paper) for married female applicants who wish to apply for change of name due to marriage. ADDITIONAL REQUIREMENT AS PRESCRIBED BY RESPECTIVE BOARDS

a. ARCHITECTS - UAP MEMBERSHIP ID/CERTIFICATION OF GOOD STANDING b. CUSTOMS BROKER CERTIFICATION OF GOOD STANDING FROM CCBI c. ELECTRONICS ENGR/PROF. ELECTRONICS ENGR./ELECTRONICS TECHNICIAN -IECEP CERTIFICATION OF GOOD
STANDING

d. GEODETIC ENGINEER. - G.E.P. MEMBERSHIP ID/CERTIFICATION OF GOOD STANDING e. GUIDANCE AND COUNSELING VALID CERTIFICATE OF PGCA MEMBERSHIP AND ANNUAL PAYMENT RECEIPTS f. MECHANICAL ENGR/PROF. MECHANICAL ENGR/CERTIFIED PLANT MECHANIC CERTIFICATION OF GOOD STANDING g. h.
FROM PHILIPPINE SOCIETY OF MECHANICAL ENGINEERS holding office at Don Lorenzo Bldg., P. Paredes St., Sampaloc, Manila and its duly accredited regional chapters PROF. AGRI. ENGRS. FILL-UP DATA FORM AND SUBMIT PSAE ID/CERTIFICATION OF GOOD STANDING REGISTERED ELECTRICAL ENGRS./RME/PEE - IIEE MEMBERSHIP ID/CERTIFICATION OF GOOD STANDING PROCEDURES

Step 1 - Get renewal form from the Public Assistance and Complaints Desk (for married female applicants, get also petition form for change
of name due to marriage).

Step 2 - Accomplish renewal/petition form and paste passport-size colored picture in white background with complete nametag. Step 3 - Proceed to Renewal Section (Window 7 or 8) and present your accomplished renewal/petition form and Professional Identification
Card for assessment of fees and evaluation of requirements.

Step 4 - Pay the renewal fees at Cashier (Window 5 or 6 located at the back entrance). Step 5 - Proceed to Renewal Section (Window 7 or 8) and submit renewal/petition form, official receipt, photocopy of

Professional Identification Card, and 1 passport-size picture, and original NSO marriage certificate (for married female applicants only). Receive your claim slip from the registration officer.

Note: To claim ID, present this Claim Slip at Window 9. Representative claiming the ID must present Authorization Letter from the Professional, Valid ID and Claim Slip.

As the authorized representative, I assume direct and full responsibility/liability for the professional ID card released to me. Attached is my authorization signed by the licensee.
________________________________________________________________

Signature over Printed Name of REPRESENTATIVE