Serial # _____________

PRC Form 203-A

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 tunay
na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at mga atas na ipinahahayag
ng mga sadyang itinakdang kapangyarihan ng Republika ng Pilipinas; at kusa kong babalikatin ang
pananagutang 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 akong
manghahawakan 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 sa
isang 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:
Male
Female


Civil Status:
Single Widow/er
Married Separated
Date of Birth:

Spouse Name Citizenship:


Fathers Name Citizenship:

Mothers Name Citizenship:

TEAR HERE
C L A I M S L I P

Name:____________________________________ 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

Registration Date:


REGISTRATION OF NEW PROFESSIONAL


PROCEDURES


STEP 1 Accomplish the Oath Form
STEP 2 Pay for metered documentary stamps at the Customer Service Center
STEP 3 Present duly accomplished Oath Form to the OPT Registration Officer at OPT
Window for record verification
STEP 4 Pay the prescribed fees at the Cashier (Window 17)
STEP 5 Sign in the Registry Book, receive your claim slip at OPT Window
STEP 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 Propesyonal
Metered Documentary Stamps for the Oath Form
Current 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 for
Board 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 the
Registry Sheet.

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




NOTE: REPRESENTATIVE WITH VALID ID SHOULD PRESENT SPECIAL POWER
OF ATTORNEY FROM THE REGISTERED PROFESSIONAL AND THIS
ORIGINAL CLAIM SLIP. PROFESSIONAL WITH UPDATED PRC ID WHO IS
ACTING REPRESENTATIVE MAY ONLY PRESENT AUTHORIZATION
LETTER AND HIS/HER ID AND THIS ORIGINAL CLAIM SLIP) (as per
OFFICE ORDER 2003-164 dated October 07, 2003)