ANNEX C - Application Form As Local CPD Provider

ANNEX “C”
Professional Regulation Commission

APPLICATION FORM
Accreditation as Local CPD Provider
CPD Council for ____________________

New Renewal Accreditation No.
Expiry Date
Part I. Personal / Corporate Information

Name of Provider:
Classification:
Individual/Sole Proprietorship Firm/Partnership/Corporation Government Institution/Agency
Address:
Telephone No.: Fax No.:
E-mail Address: Website:
Contact Person: Contact No.:
Part II. Acknowledgment

I HEREBY CERTIFY that the above information SUBSCRIBED AND SWORN to before me this _____
written by me are true and correct to the best of my day of _______________ 20__ at
knowledge and belief. I further authorize PRC and ____________________, affiant exhibited to me
other agencies to investigate the authenticity of all the his/her valid government issued ID _______________
documents presented. issued at _______________ on _______________.
_____________________________
Signature Over Printed Name _____________________________
_____________________________ (Notary Public)
Position
_____________________________
Date
Part III. Action Taken
Standards & Inspection Division – CPD: Cash Division:
Processed by: _______________ Amount : ______________

Date : _______________ O.R.No./Date : ______________
Issued by : ______________
Reviewed by:
OIC, Standards and Inspection Division
ACTION TAKEN BY THE CPD COUNCIL
Approved Accreditation No. __________________

Deferred pending compliance ______________________________________
______________________________________________________________
Disapproved due to ______________________________________________
______________________________________________________________
______________________________
Chairperson
____________________________ ____________________________
Member Member
Date____________________
ANNEX “C”
PROCEDURE FOR ACCREDITATION AS LOCAL CPD PROVIDER

Step 1. Secure Application Form at the Standards and Inspection Division counter (Window 3) or download
at PRC website (www.prc.gov.ph).
Step 2. Fill-out Application Form and comply the required documents. Application should be filed in three (3)
copies: One (1) original signed and two (2) photo copies with the complete requirements with folder
and fastener. (Please provide one (1) set for receiving copy)
Step 3. Proceed to Standards and Inspection Division processing window for evaluation and assessment.
Step 4. Pay prescribed fee (in cash, Postal Money Order, Manager’s Check, Bank Draft payable to
Professional Regulation Commission) of Five Thousand Pesos (P 5,000.00).
Step 5. Submit Application Form with attached supporting documents and three (3) photocopies of official
receipt to the Standards and Inspection Division designated window.
CHECKLIST OF REQUIREMENTS
SUPPORTING DOCUMENTS
Individual / Sole Proprietor Firm / Partnership / Corporation Government Institution/Agency
[ ] Résumé must include: [ ] Company Profile must [ ] Agency Profile must include
relevant Educational Include Mission, Vision, Name of Head of Agency
background, current Core Values and if any, a and the Head of
employment, profession, valid list of previous training Department in charge of
Professional Identification activities conducted continuing education/
Card, principal area of [ ] List of Officers with valid training
professional work & No. of Professional ID Card (if [ ] Copy of charter or Republic
years in the practice of the applicable) Act establishing the agency
regulated profession [ ] List and photographs of [ ] List and photographs of
[ ] Company Profile must include training equipment and training equipment and
Mission, Vision, Core Values facilities facilities
and if any, a list of previous [ ] Instructional Design (one) [ ] Instructional Design (one)
training activities conducted [ ] Annual plan of proposed [ ] Annual plan of proposed
[ ] List and photographs of CPD Activities CPD Activities
training equipment and [ ] Appointment paper from the [ ] Office Order from the head
facilities managing partner or Board of Agency appointing its
[ ] Instructional Design (one) Resolution of a Corporation officer to manage the CPD
[ ] Annual plan of proposed CPD authorizing a partner or activities
Activities officer to manage the CPD [ ] Notarized Affidavit of
[ ] DTI Certificate of Registration activities Undertaking (___________)
(authenticated copy) [ ] SEC Certificate of
[ ] NBI Clearance (original) Registration and Articles of
[ ] BIR Certificate of Registration Incorporation or Partnership
(authenticated copy) and their respective By-laws
[ ] Notarized Affidavit of (authenticated copy)
Undertaking (____________) [ ] BIR Certificate of
Registration
(authenticated copy)
[ ] Notarized Affidavit of
Undertaking (___________)
Renewal
[ ]
List of CPD activities for the last 3 years
[ ]
List and photographs of training equipments and facilities
[ ]
Annual plan of proposed CPD Activities
[ ]
General Information Sheet for Corporation or Partnership
[ ]
Amended Articles of Incorporation or Partnership and their respective by-laws, if there are changes
[ ]
Appointment paper from the managing partner or Board Resolution of a Corporation authorizing a partner or
officer to manage the CPD activities or Office Order from the head of government agency appointing its officer
to manage the CPD activities, if there are changes.
[ ] Notarized Affidavit of Undertaking (_______________)
Additional Requirements:
[ ] Short brown envelope for the Certificate of Accreditation
[ ] One set of metered documentary stamps worth Twenty-One Pesos (P25.00) to be affixed to the
Certificate of Accreditation. (Available at PRC Customer Service and PRC Regional Offices)
Note:
1. Representative/s filing application/s for accreditation and claiming the Certificate of Accreditation in
behalf of the applicant must present a letter of authorization and valid identification cards of both the
authorized signatory and the representative.
2. The period for processing the application is 30 days.
3. If additional requirement/s is/are needed, a period of 7 days is given to submit the same. Failure to
comply within the period shall be construed as abandonment of application and the prescribed fee shall
be forfeited in favor of the government.

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ANNEX “C”

Professional Regulation Commission

CPD Council for ____________________

Part I. Personal / Corporate Information

Telephone No.: Fax No.:

E-mail Address: Website:

Contact Person: Contact No.:

Part II. Acknowledgment

Processed by: _ Amount :

OIC, Standards and Inspection Division

ACTION TAKEN BY THE CPD COUNCIL

Approved Accreditation No. __________________

PROCEDURE FOR ACCREDITATION AS LOCAL CPD PROVIDER

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