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Professional Regulation Commission

This document is an application for a Professional Identification Card (PIC) renewal from the Professional Regulation Commission. It contains details of the applicant such as name, citizenship, address, license information. It also includes a declaration that is signed by the applicant agreeing to the collection and use of their personal information. For those who did not complete the required continuing professional development units, there is an undertaking to be signed committing to submit the outstanding units for the next renewal.

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Ronald James Condino Reil
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134 views

Professional Regulation Commission

This document is an application for a Professional Identification Card (PIC) renewal from the Professional Regulation Commission. It contains details of the applicant such as name, citizenship, address, license information. It also includes a declaration that is signed by the applicant agreeing to the collection and use of their personal information. For those who did not complete the required continuing professional development units, there is an undertaking to be signed committing to submit the outstanding units for the next renewal.

Uploaded by

Ronald James Condino Reil
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
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TIME RECEIVED:

TIME RELEASED:

Professional Regulation Commission

APPLICATION FOR PROFESSIONAL IDENTIFICATION CARD (PIC)

NOT FOR SALE (REPRODUCTION IS ALLOWED)

APPOINTMENT DATE: August 14, 2019 (12:00 PM TO 01:00 PM) - Robinsons Place Naga
REFERENCE NO: RELH3VXJCF2O | OR: 15732154 | Amount: PHP 450
NAME: REIL, RONALD JAMES CONDINO

CITIZENSHIP: FILIPINO BIRTHDATE: August 15, 1995

PERMANENT MAILING ADDRESS: AZUCENA


TEL. NO. / CP NO.: 09219384659 EMAIL ADDRESS: [email protected]
SCHOOL GRADUATED: DATE GRADUATED:
CENTRAL BICOL STATE UNIV. OF AGRICULTURE-(for.CSSAC)-SIPOCOT April 08, 2016
REGISTRATION DATE: December 22, 2016 EXPIRATION DATE: August 15, 2022
PROFESSION: PROFESSIONAL TEACHER LICENSE NO.: 1513147

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
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