REFERENCE NO: RE3PVNOBUSIB | APPOINTMENT DATE: February 24, 2025 - 08:00 AM-09:00 AM

Professional Regulation Commission

APPLICATION FOR RENEWAL OF PROFESSIONAL
IDENTIFICATION CARD (PIC)

APPOINTMENT DATE: February 24, 2025 - 08:00 AM-09:00 AM O.R. NO. / DATE: E2025-02-11026735 - February 19, 2025
PLACE: PRC Iloilo TEL NO./CP NO.: 09300258450
LAST NAME: NIEVES FIRST NAME: CHERRY MAE
MIDDLE NAME: SUBALDO MAIDEN NAME (if married): N/A
PROFESSION: MIDWIFE LICENSE NO: 0178055
REGISTRATION DATE: January 21, 2019 EXPIRATION DATE: April 16, 2028
CITIZENSHIP: FILIPINO CIVIL STATUS: SINGLE
BIRTHDATE: April 16, 1996 EMAIL ADDRESS: [email protected]
PERMANENT MAILING ADDRESS: . . BRGY. BAD-AS
CURRENT EMPLOYER (if employed): LGU SAN JOAQUIN OFFICE ADDRESS: PUROK 3, SAN JOAQUIN, ILOILO

CONFORME:

I agree to the PRC Privacy Notice and give my consent to the collection and processing of my personal data in accordance thereto.

CHERRY MAE SUBALDO NIEVES

(SIGNATURE OVER PRINTED NAME)

CPD UNDERTAKING:

I hereby undertake to comply with the CPD requirements in the next compliance period.

SIGNATURE OF LICENSEE

Basic Requirements:
1. Proof of system generated signed application form for the renewal of Professional Identification Card (PIC).
2. Certificate of attendance to accredited Continuing Professional Development (CPD) seminars (Annex A) validated through the CPD
Accreditation System (CPDAS), otherwise sign CPD Undertaking.
3. Other documents as may be prescribed by the Professional Regulatory Law of the concerned profession i.e. Certificate of Good
Standing, Surety Bond for Real Estate.

Additional Requirements:
1. For Overseas Filipino Professionals (OFPs), in lieu of CPD Certificates shall submit any of the following:.
a. Overseas Employment Certificate (OEC) from Philippine Overseas Employment Administration (POEA);
b. Passport and working visa or permit (in a foreign country);
c. Contract of Service or Employment Overseas;
d. Company Identification Card (foreign company);
e. Residence permit/permit to stay in a foreign country; or
f. Other credible proof/s of identity or status as OFP
2. A former Filipino professional who has reacquired Philippine citizenship shall submit the following:
a. Certificate of Reacquisition/Retention of Philippine Citizenship (CRPC) issued by the Bureau of Immigration (BI); and
b. Copy of new Oath Form (Panunumpa ng Propesyonal)
3. For professionals with dual citizenship, shall submit any of the following:
a. Proof of Philippine citizenship (i.e. valid Philippine passport);
b. Oath of Allegiance from Philippine Consulate and Identification Certificate of Philippine Citizenship issued by the Bureau of
Immigration; and
c. Certificate of Retention or Re-acquisition issued by Bureau of Immigration

Requirements for Representative:

1. Non-registered professional - any valid government-issued ID and Special Power of Attorney (SPA) duly executed individually by the
applicant.

PRD-27
Rev. 02
February 15, 2024
Page 1 of 2
 2. Registered professional - valid Professional Identification Card/e-PIC and authorization letter duly signed by the concerned applicant.

Procedures:
1. Log in using LERIS account https://online.prc.gov.ph to secure an appointment date and place, and select payment option/channel. If
the client opts for the delivery of printed PRC PIC, select shipping button, input shipping details and select payment options. .
2. Present the proof of system-generated Application Form for the Renewal of PIC and other documentary requirements to the
designated window.
3. Receive the valid PIC and sign on the releasing log sheet.

PRD-27
Rev. 02
February 15, 2024
Page 2 of 2
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