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Serial # _____________

Republic of the Philippines

Professional Regulation Commission

Lucena City

PANUNUMPA NG PROPESYONAL

LUPON ng mga GURO

Ako, si ________________________________________________________ng _______________________________________________________________________________________

(Pook na Sinilangan: Bayan/Lungsod, Probinsya)

ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na akoy tunayna mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga atas na ipinahahayagng mga sadyang itinakdang kapangyarihan ng Republika ng Pilipinas; at kusa kong babalikatin angpananagutang ito, na walang ano mang pasubali o hangaring umiwas.

Taimtim pa rin akong nanunumpa na sa lahat ng panahon at pook na kinaroroonan ay mahigpit akongmanghahawakan sa mga etikal at tuntuning propesyonal ng mga GURO sa Pilipinas, at matapat kong

gagampanan ng buong husay sa abot ng aking makakaya ang mga tungkulin at pananagutang iniatang saisang itinakdang GURO.

Kasiyahan Nawa Ako ng Diyos.

__________________________________(Lagda)

A- ________________________(Bilang ng Sedula)

__________________________(Kinuha sa)

_______________________(Petsa)

Nilagdaan at Pinanumpa sa harap ko ngayong ika _________ ng ______________________________

taon ng ating Panginoon _____________ sa _____________________________, Pilipinas.

Level Elem Sec

Reg/Lic. No. ______________

Reg. Date ________________

O.R. No. _________________

Date Paid ________________

_______________________________

(Pinunong Tagapanumpa)

_______________________________

(Katungkulang Opisyal)

Verified and Assessed By:______________

PERSONAL DATA

Date of Examination: LET _____________________Contact No.: _____________________

WITHOUT EXAM:Resolution No.: ________________Dated: _______________________

Sex:MaleFemale

Civil Status:Single Widow/erMarried Separated

Date of Birth:

Spouse Name Citizenship:

Fathers NameCitizenship: Mothers NameCitizenship:

TEAR HERE

C L A I M S L I PName:____________________________________ LEVEL: Elementary Secondary

Registration / License No.:____________________ Major: ________________Please present this slip to claim your professional ID after 3 to 4 months at Windows 6.

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31*** Please read procedures and requirements at the back.

_________________________

OPT Registration Officer

__________

Date========================================================================================================================================

2/F LUCENA GRAND CENTRAL TERMINAL, INC., ILAYANG DUPAY, LUCENA CITY, PHILIPPINES

(042) 373-7316 FAX (042) 373-7305 www.myprclucena.multiply.com

Metered

Documentary

Stamp

COLORED

PICTURES

In plain

background

with complete

name tag

PASTE HERE

COLORED

PICTURES

In plain

background

with complete

name tag

PASTE HERE

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REGISTRATION OF NEW PROFESSIONAL

PROCEDURES

STEP 1 Accomplish the Oath FormSTEP 2 Pay for metered documentary stamps at the Customer Service CenterSTEP 3 Present duly accomplished Oath Form to the OPT Registration Officer at OPT

Window for record verificationSTEP 4 Pay the prescribed fees at the Cashier (Window 17)STEP 5 Sign in the Registry Book, receive your claim slip at OPT WindowSTEP 6 On scheduled date, present your CLAIM SLIP at OPT Window (Window 6) to

claim your Professional ID and Certificate of Registration.

REQUIREMENTS

Duly accomplished Oath Form or Panunumpa ng PropesyonalMetered Documentary Stamps for the Oath FormCurrent Community Tax Certificate (CEDULA)Two (2) pieces passport size pictures with white background and complete name tag

(last name, first name, middle name) one (1) for the Oath Form & the other forBoard Certificates)One (1) pc 1x1 picture with white background and complete name tag

IMPORTANT

Initial registrants should come personally to the PRC Central Office or the nearest

Regional Office to file his/her application for registration and affix his/her signature on theRegistry Sheet.

Professional Identification Card and Certificate of Registration shall be claimed bythe licensee personally at the Central Office of the Regional Office where the applicationfor the same has been filed. If there is an unavoidable need for a representative, he mustpresent his identification paper and Special Power of Attorneyfrom the registrant/licensee.(Office order No. 36 dated April 02, 2002)

NOTE: REPRESENTATIVE WITH VALID ID SHOULD PRESENT SPECIAL POWEROF ATTORNEY FROM THE REGISTERED PROFESSIONAL AND THISORIGINAL CLAIM SLIP. PROFESSIONAL WITH UPDATED PRC IDWHO ISACTING REPRESENTATIVE MAY ONLY PRESENT AUTHORIZATIONLETTER AND HIS/HER ID AND THIS ORIGINAL CLAIM SLIP) (as perOFFICE ORDER 2003-164 dated October 07, 2003)