Eligibility/Exam Records Request Form (ERRF) Republic of the Philippines Date Accomplished by Client:

(Revised 01192011) CIVIL SERVICE COMMISSION

OFFICE NAME Time Accomplished by Client:
CIVIL SERVICE
OFFICE COMMISSION
NAME Time Received by ESD/ERS Personnel:
REQUEST FOR ELIGIBILITY/EXAMINATION RECORDS Initials of ESD/ERS Personnel:
Certification of Eligibility Authentication of Eligibility Others
(no/lost original certificate; attach Declaration) (attach original certificate)
PERSONAL INFORMATION (Please print. ) Gender:
Name Used at the Time Civil Status:
of Issuance/Exam: Last Name First Name Middle Name Presently employed? Yes No
Current Name: If yes, please specify:
Address Used at the Time of Issuance/Exam: Company:
Current Address: Address:
Date of Birth: Place of Birth:
Purpose/s of Request: Employment Replacement of Lost Certificate Did Not Receive Original Certificate
Promotion Replacement of Old/Torn/Worn-out Certificate Others
ELIGIBILITY/EXAMINATION DATA (Please print.)
Title of Eligibility/Exam: Rating Obtained: Date of Effectivity:
Date of Issuance/Exam: Registration/Certificate/Card/Resolution No.:
Place of Issuance/Exam: Registration/Certificate/Card/Resolution Date:
Requested By:

Signature of the Eligible/Examinee Right Thumb Print Authorized Representative

Signature at the Time of Issuance/Exam (Printed Name & Signature)
Contact No. (Examinee/Eligible) Contact No.
ACTION TAKEN
CHECKED DATA AGAINST THE ML CHECKED DATA AGAINST THE PSP
Book No. Page No. Seq./Line No. In Order Not In Order
School Code/Batch No. Examinee/Reg. No. Photo/Picture
Date Issued/Released: Signature
NO AVAILABLE RECORD Date of Birth
REMARKS REMARKS
Name/Signature/Initials: Security Form No.:
1st Verifier: 2nd Verifier: 1st Validator: 2nd Validator:
Date: Date: Date: Date:
RELEASE OF REQUEST/S Released by Received by
Fee: O.R. No.: Date:
Date: Action Officer Signature of Eligible/Representative Time:
(Please see Guide and Checklist of Requirements at the back page.)
(Revised 10032012)
A. CERTIFICATION OF ELIGIBILITY (for no/lost original certificate)
1. One piece 1" x 1" photo with printed name and signature affixed prior to having the picture taken
• Printed married name (for married women);
• Signature must be on top of the printed name.
• Photo should have been taken within three (3) months prior to filing of request for Certification of Eligibility;
• Scanned, computer-generated photo/name/signature will not be accepted;
2. Original and properly accomphlished ERRF and Declaration Form (DF). DF should be handwritten
and personally accomplished by the eligible.
3. Original copy of two (2) valid government issued ID Cards, or if the requesting party is abroad, please refer to
additional requirements below;
4. Original and clear photocopy of Marriage Contract (for married women);
5. Certification fee: Php 100.00 per copy; and
6. If through a representative, please refer to additional requirements below.

B. AUTHENTICATION OF ELIGIBILITY
1. Original Certificate of Eligibility or Report of Rating;
2. Original and properly accomplished ERRF;
3. Original copies of two (2) valid government issued ID Cards of the eligible, or if the requesting party is abroad,
please refer to additional requirements below;
4. Original and clear photocopy of Marriage Contract (for married women);
5. Auhtentication fee: Php 50.00 per copy; and
6. If through a representative, please refer to additional requirements below.
Choices for Government Issued ID Card/s:
1. Office ID 4. SSS/GSIS or UMID 7. NBI Clearance 10. Voter's ID
2. Taxpayer's ID 5. Driver's License 8. Police Clearance 11. NBT License
3. Passport 6. PRC License 9. Postal ID 12. Senior Citizen's ID

ADDITIONAL REQUIREMENTS
A. If request for certification or authentication is filed through a Representative:
1. Original Special Power of Attorney (SPA) or Authorization letter with hand-printed name and signature of
authorized representative; and
2. Original copy of one (1) valid ID Card of the representative.
B. If the requesting party of the certification or authentication Works/Lives Abroad:
1. Clear photocopy of Passport; and duly authenticated/validated by the Philippine Embassy or
2. Clear photocopy of one (1) valid ID Card. Consular Office

The accomplished forms (ERRF and Declaration Form) may be submitted or sent through mail, together with the other requirements to the CSC Regional Office
which conducted the examination or to the Integrated Records Management Office, Civil Service Commission, Constitution Hills, Quezon City
 ERRF Attachment
To COE Request
DECLARATION

That, I, _________________________________________________, Filipino citizen, of legal age,

(First, Middle, and Last Name)
_________________, and a resident of ________________________________________, hereby state:
(Civil Status) (Address)

That, I am a _______________________________ eligible. My eligibility was issued/granted by the

*(Type of Eligibility/Examination)
Civil Service Commission _____________________________________ on _________________________.
(Central/Regional Office or Place of Issuance/Exam) (Date of Issuance/Exam)

(Please read Categories A-C and check/choose 1 ONLY.)

A. That, I lost my Report of Rating (ROR) or Certificate of Eligibility (COE) on ___________________,

because of: (Date)
_____theft _____flood/typhoon _____other reason/s
_____fire _____transfer of residence _____________________
_____termites _____misplacement/negligence _____________________

That, despite diligent search and efforts to locate the said ROR/COE, I could not find the same such
that I believe it is lost and beyond recovery.

B. That, I am not in possession of my Report of Rating (ROR) or Certificate of Eligibility (COE), because:
_____I did not receive/claim/pick-up my ROR or COE
_____I submitted my ROR or COE to the agency/employer

C. That, I want to replace my Report of Rating or Certificate of Eligibility, because:

_____it is old/torn/worn-out
_____my request for correction of my personal information has been duly granted by the CSC

That, I am executing this Declaration to attest to the truth of the foregoing, and, in support of my
request for certification of my eligibility. Under oath, I declare under penalty of perjury that this has been
accomplished by me, and is true, correct and complete statement pursuant to the provisions of pertinent
laws, rules and regulations of the Republic of the Philippines.

____________________________ ______________
(Signature of Eligible/Examinee) (Date) (Right Thumb Print)

Identification Cards presented:

Issued by: Issued at: Date of Issuance:
1 ______________________ _____________________ _____________________
2 ______________________ _____________________ _____________________

NOTE: ALL DETAILS FROM NAME TO IDENTIFICATION CARDS PRESENTED

SHOULD BE ACCOMPLISHED BY THE ELIGIBLE/EXAMINEE

*e.g. Career Service Professional/Subprofessional PD 907 RA 1080 (Professional/Subprofessional/Teacher)

Police Officer / Police Officer I Barangay Official MC 11 (Data Encoder, Plumber, Carpenter, etc.)
Professional Board Examination for Teachers Stenographer Res. 435 (Security Guard, Messenger, etc.)
Fire Officer / Penology Officer Agricultural Officer Others
Revised 01192011