Scribd
Upload
82 views1 page

Professional Regulation Commission

This document is an application for a Professional Identification Card (PIC) renewal for Jonavelle Cubrado Ramos. It contains her personal details like name, citizenship, birthdate, address and contact information. It also lists her professional details like the school she graduated from, date of graduation, date of registration, profession, license number and expiration date. The document contains declarations that she consents to the collection of her data and that the information provided is true. For those who did not meet the required CPD units, there is an undertaking to submit the remaining units for the next renewal.

Uploaded by

Jonavelle Ramos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
82 views1 page

Professional Regulation Commission

This document is an application for a Professional Identification Card (PIC) renewal for Jonavelle Cubrado Ramos. It contains her personal details like name, citizenship, birthdate, address and contact information. It also lists her professional details like the school she graduated from, date of graduation, date of registration, profession, license number and expiration date. The document contains declarations that she consents to the collection of her data and that the information provided is true. For those who did not meet the required CPD units, there is an undertaking to submit the remaining units for the next renewal.

Uploaded by

Jonavelle Ramos
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

TIME RECEIVED:

TIME RELEASED:

Professional Regulation Commission

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD (PIC)

NOT FOR SALE (REPRODUCTION IS ALLOWED)

APPOINTMENT DATE: June 30, 2020 (11:00 AM TO 12:00 PM) - Robinsons Place Tagum
REFERENCE NO: REVMZL9JI1SD | OR: 016006417402 | Amount: PHP 450.00
NAME: RAMOS, JONAVELLE CUBRADO

CITIZENSHIP: FILIPINO BIRTHDATE: May 15, 1996

PERMANENT MAILING ADDRESS: PRK. HAYAHAY, POBLACION, LUPON


TEL. NO. / CP NO.: 09510268330 EMAIL ADDRESS: [email protected]
SCHOOL GRADUATED: DATE GRADUATED:
DAVAO ORIENTAL STATE COLLEGE OF SCIENCE & TECHNOLOGY April 20, 2016
REGISTRATION DATE: February 15, 2017 EXPIRATION DATE: May 15, 2023
PROFESSION: PROFESSIONAL TEACHER LICENSE NO.: 1529672

DECLARATION AND ATTESTATION

I am aware and I give my consent to the collection of the data required by this application form and
the taking of my photograph, and if applicable, the taking of my fingerprints.

I further attest that all particulars and supporting documents provided by me are correct and
complete. I am aware that any false statement or fraudulent document will lead to the rejection of my
application or to the cancellation of my PIC already issued, and may also render me liable under applicable
administrative and criminal laws.

SIGNATURE OF LICENSEE

UNDERTAKING

(To be filled up by professionals, except for Real Estate Practitioners, who failed to comply with the
required CPD Credit Units for the renewal of Professional Identification Card)

For this compliance period, I am submitting CPD units of the total required CPD Credit units. I
hereby undertake to submit the balance of CPD credit units in addition to the required CPD units (or a
total of units) for the next renewal of my PIC. I understand that in the event I fail to comply, my PIC will
not be renewed.

SIGNATURE OF LICENSEE

NOTE:
1) ALL REAL ESTATE PRACTITIONERS CANNOT AVAIL THE UNDERTAKING AND HAVE TO
PROVIDE PROOF OF COMPLIANCE WITH CPD PRIOR TO RENEWAL OF PIC PURSUANT TO
SECTION 17, ARTICLE III OF REPUBLIC ACT NO. 9646 OR THE REAL ESTATE SERVICE ACT
OF THE PHILIPPINES AND BOARD RESOLUTION NO. 49, S. 2015.
2) REPRESENTATIVE OF THE PROFESSIONAL APPLYING FOR ISSUANCE OF PROFESSIONAL
IDENTIFICATION CARD (PIC) MUST SUBMIT:
a) THE PRESCRIBED AUTHORIZATION LETTER AND PHOTOCOPY OF PROFESSIONAL
IDENTIFICATION CARD (PIC) OF THE REPRESENTATIVE AND EXPIRED PIC OF THE
PRFESSIONAL; OR
b) SPECIAL POWER OF ATTORNEY (SPA) AND PHOTOCOPY OF ANY VALID GOVERNMENT
ISSUED IDENTIFICATION CARD (ID) OF THE REPRESENTATIVE AND THE PROFESSIONAL
3) STRICTLY FOLLOW THE APPOINTMENT DATE ON RENEWAL OF PROFESSIONAL
IDENTIFICATION CARD (PIC).

REG-03
Rev. 02
September 15, 2017
Page 1 of 1

You might also like