PRC APP Form No. 001 (Rev. Sept.

2004)

_________________________
NAME OF EXAMINATION
Paste here
_________________________ your recent
Date of Examination 1½x1½
Republic of the Philippines Colored picture with
_________________________ Complete name tag
Place of Examination In plain white
Manila background
First Timer
Repeater APPLICATION DIVISION
Conditional/Removal
(Subjects to be taken)
_________________________
_________________________ DATE OF FILING: _______________
_________________________ PERRC No. ____________________

LAST NAME FIRST NAME MIDDLE NAME

MAILING ADDRESS

DATE OF BIRTH PLACE OF BIRTH CELL PHONE/TEL. NO.

(mm/dd/yy)

NAME/LOCATION OF SCHOOL DATE OF GRADUATION

(mm/yy)

PREVIOUS PRC EXAMINATION(S) TAKEN

DATE TAKEN RESULT OF EXAMINATION (Pls. Check) VERIFIED (Records Section)
NAME OF EXAMINATION RATING
(mm/yy) Passed Failed Conditioned (Full Signature)

__________________________
Applicant's Signature
DO NOT FILL UP BELOW THIS LINE

1. ACTION TAKEN BY THE PROCESSOR

Checklist of Requirements
Original and photocopy of Transcript of Records w/ scanned
Picture, remarks “FOR BOARD EXAM PURPOSES “,
Special Order and Date of Graduation,Course & Degree
Original and photocopy of Birth Certificate (NSO)
Original and photocopy of Marriage Contract (NSO)
(for married female only)
Certification of Good Moral Character (Agri, Crim.,
Fish. Tech., Forester, Librarian, Environmental Planner)
Four (4) 1 ½ x 1 ½ colored pictures with full name tag
Community Tax Certificate (cedula)
Any valid identification card
Refresher Course (CPA, Med. Tech., PT, OT, Physician, Pharm, Optometry)
Copy of College Thesis – Approval & Title Page (Chemist)
Certificate of Experience (RME, CPM, Master Plumber, Env'tal Planner, Landscape Arch. )
Affidavit of Competency (PME, CPM)
Certificate of Employment (RME, CPM, Master Plumber, Env Plnr)
Detailed Description of Equipment (CPM)
Diploma, Logbook/Mentor's Prof. License , PTR & IAPOA (Architect)
Daily Time Record (Pharmacist)
Certificate of Internship (Physician, Pharm, PT, OT)
Record of Deliveries Handled (Midwife)
NBI Clearance (Arch/CPA/Crim/Chem Eng/ Vet med)
Summary of Related Learning Experience (Nurse)
Record of OR-DR Cases (Nurse)
Certificate of 1,000 Cases Hours (Social Worker)
Certification of Mine and Mill Practice (Mining Engr.)
Board Certificate/PRC License (Ocular Pharm, Nurse-Midwife)
Certificate of Special Pharmacology Course
OTHERS ____________________________________
____________________________________
Issuance of the following forms
Computerized Application Form (CAF)
Notice of Admission (NOA)
Permanent Examination & Registration Record Card
(PERRC)

Remarks: _______________________________________________________________________________________
PROCESSOR _________________________________________ DATE ____________________________________
(Full Signature)
2. ACTION TAKEN BY THE LEGAL DIVISION (as applicable)
Remarks: ______________________________________________________________________________________
LEGAL OFFICER ______________________________________ DATE ___________________________________
3. ACTION TAKEN BY THE BOARD
APPROVED DISAPPROVED CONDITIONAL
Remarks: ______________________________________________________________________________________
CHARIMAN / MEMBER _________________________________ DATE ___________________________________
4. ACTION TAKEN BY THE CASHIER
AMOUNT _______________________________ OFFICIAL RECEIPT No. __________________________________
RECEIPT ISSUED BY ___________________________________ DATE ___________________________________
5. ACTION TAKEN BY THE ISSUING OFFICER
Remarks ______________________________________________________________________________________
ISSUING OFFICER ____________________________________ DATE ___________________________________
(Full Signature)
6. NOTICE OF ADMISSION, PROGRAM OF EXAMINATION and EXAMINEE'S GUIDE received by _________________
STEP 1. Secure Action Sheet from the PRC Customer Service Center (CSC) and accomplish the same.
STEP 2. Submit the Action Sheet for processing and evaluation at any of the Application Division Processing
Windows (Windows 5, 6, 7 or 8) together with the following:
Original and photocopy of Transcript of Records with Special Order, Date of Graduation, Scanned picture
and remarks “FOR BOARD EXAM PURPOSES” (Graduates of government schools and
institutions/programs accredited by recognized accrediting agencies under the FAAP are exempted from
S.O. [B]).
Original and photocopy of NSO-issued Birth Certificate in security paper. Birth Certificate from the LCR is
required if the NSO Birth Certificate is not readable. If there is no record of birth in NSO, the negative
certification is submitted together with an authenticated copy of the LCR by NSO.

NOTE: Graduates from new schools/programs are required to present CHED Recognition/ Permit

Original and photocopy of Marriage Contract from NSO in security paper (for married female only).
Four (4) passport size colored pictures in plain white background with complete name tag.
Current Community Tax Certificate (Cedula).
One (1) window mailing envelope with metered postage stamp.
Other specific requirements as required by the Commission and/or the Professional Regulatory Board.

Secure the following from the processor upon approval of your application :
Computerized Application Form (CAF)
Permanent Examination and Registration Record Card (PERRC)
Notice of Admission (NOA)

STEP 3. Pay examination fee at any of the Cashier Windows (Windows 1, 2, 3 or 4). Get Official Receipt.

STEP 4. Accomplish the CAF, PERRC and NOA. Indicate the Official Receipt number, date, and amount on the CAF.

STEP 5. Pay for metered documentary stamp and mailing envelope with metered documentary stamp at the CSC.

STEP 6. Proceed to any of the Issuance Windows (Windows 9, 10, 11 or 12) for final review of qualifications and
documents and issuance of NOA, Applicant's Stub, Program of Examination; Examinee's Guide and Self-Instruction
Sheet (Please do not bring home your application and other documents).

STEP 7. Keep the Notice of Admission, Official Receipt, and the Applicant's Stub. Bring these with you on the first
day of the examination. For further information, read the General Instructions at the back page of the NOA, Program
of Examination, Examinee's Guide and Self-Instruction Sheet.

STEP 8. Bring your NOA when you verify with the PRC your school/building assignment which will be posted at the
PRC premises two (2) or three (3) working days before the examination date.

1. Refer to the MASTER LIST OF ADDRESS CODES posted at the PRC premises for the codes of town, city,
and province of your residence, postal address, and place of birth. (This is different from zip codes.)
2. Refer to the MASTER LIST OF SCHOOL CODES also posted at the PRC premises for the
school/college/university and location.
3. Refer to the MASTER LIST OF COURSE CODES for the course code.
4. Please indicate your REVIEW SCHOOL CODE.
5. For STATUS CODES, use the following:
a) EX CODE – Examination Type Code
Print "1" for Complete or First Time Print "5" for Practical only
Print "2" for Repeater Print "6" for Prelims
Print "3" for Removal/Conditioned Print "7" for Finals
Print "4" for Theory only Print "8" for Finals with Prelims
b) NX CODE – Number of Times Taken
Print "0" for None
Print "1" for Once
Print "2" for Twice ….. and so on
c) DEF CODE – Print "00"