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Master Plumber

The document is an application form for the Master Plumber examination scheduled on July 12 & 13, 2025, at Rosales, Pangasinan. The applicant, Jayve Macasieb Daroy, is a first-time examinee who graduated with a Bachelor of Science in Architecture from Lyceum Northwestern University. The application includes personal information, educational background, and a certification statement regarding the truthfulness of the provided information.

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jayvedaroy909
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11 views1 page

Master Plumber

The document is an application form for the Master Plumber examination scheduled on July 12 & 13, 2025, at Rosales, Pangasinan. The applicant, Jayve Macasieb Daroy, is a first-time examinee who graduated with a Bachelor of Science in Architecture from Lyceum Northwestern University. The application includes personal information, educational background, and a certification statement regarding the truthfulness of the provided information.

Uploaded by

jayvedaroy909
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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APPOINTMENT DATE: May 20, 2025 (10:00 AM TO 11:00 AM) - Robinsons Place Pangasinan

Professional Regulation Commission

APPLICATION FORM

NOT FOR SALE (REPRODUCTION IS ALLOWED)


REFERENCE NO: EXYS1ZBQQAYC
Application No.
OR: E2025-05-29391762 | AMOUNT: PHP 600.00
045380
X First Timer
Repeater Name of Examination MASTER PLUMBER
_________________________________
Conditioned Date of Examination JULY 12 & 13, 2025
_________________________________
Absent
Place of Examination Rosales, Pangasinan
_________________________________
________________
05/19/2025
Date(mm/dd/yy)
NOTICE: All supporting documents shall become part of the records of the Commission. All applications must be filed
PERSONALLY by the applicant.

PART I-PERSONAL INFORMATION


SUR NAME GIVEN NAME/S MIDDLE NAME
DAROY JAYVE MACASIEB
Maiden Surname (for married female only)

Permanent Mailing Address (House no., Street, Village/Subd., Brgy., Town, Prov./City)
204 TEBENG DIST. TEBENG DAGUPAN CITY, PANGASINAN
Gender Citizenship Contact numbers (Landline & Mobile) E-mail Address
X Male Female X Filipino Others______ 09274280380 [email protected]
Civil Status Date of Birth(mm/dd/yy) Place of Birth (City/Town,Prov) RURBAN Code(Town/City,Prov)
X Single Married Widow/er 10/08/1998 DAGUPAN CITY, PANGASINAN 015518
Spouse’s name & Citizenship Father’s Name & Citizenship Mother’s Name & Citizenship
JOEY M. DAROY / FILIPINO EVA M. DAROY / FILIPINO
HAVE YOU EVER BEEN CHARGED AND CONVICTED BY FINAL JUDGEMENT BY ANY COURT OF JUSTICE/MILITARY TRIBUNAL OR
ADMINISTRATIVE BODY? X No Yes (If yes, attach hereto a copy of the decision)
PART II – EDUCATIONAL INFORMATION
Name of School Address/Location of School PRC School code
LYCEUM NORTHWESTERN UNIVERSITY-DAGUPAN CITY TAPUAC, DAGUPAN CITY, PANGASINAN 0896
Degree/Course Obtained PRC COURSE Code Date Graduated (mm/dd/yy) PRC Board Code
BACHELOR OF SCIENCE IN ARCHITECTURE 3036 06/17/2022 1900
Date Graduated PRC SCHOOL
Other Higher Educational Attainment Name of School Address/Location of School CODE
(mm/dd/yy)

PART III – PREVIOUS PRC LICENSURE EXAMINATION/S TAKEN (Last Three Exams)
Place of Date Taken Result of Examination (pls check)
Name of Examination Rating Exam No. Verified by
Examination (mm/yy) Passed Failed Cond.

Review School/Center: Self-Review School-Based Review Others (specify name) __________________________


STATUS CODES (refer at the back) 1.) Examination Type (EXcode) 2.) Number of Times Taken 0

I HEREBY CERTIFY that the information and/or ACTION TAKEN BY THE APPLICATION PROCESSOR
statements in this application including the supporting ISSUANCE of the FOLOWING FORMS
documents submitted in support thereof are all true and
correct to my own knowledge, and that I am fully aware that NOTICE OF ADMISSION PERMANENT EXAMINATION &
(NOA) REGISTRATION RECORD CARD (PERRC)
any false information or statement in this application or in its
attachments shall render me liable for criminal prosecution REMARKS ______________________________________________
and/or administrative sanction. ______________________________________________________________________________

PROCESSOR_____________________________ Date ___________


RIGHT THUMBMARK _______________________ ____________________________________________________________
Signature of Applicant ACTION TAKEN BY LEGAL OFFICER (if applicable)
_______________________ REMARKS ______________________________________________
Date Accomplished ______________________________________________________________________________

LEGAL OFFICER __________________________ Date ___________


Subscribed and sworn to before me this __________day of ____________________________________________________________
_________20____at__________. Affiant applicant exhibited ACTION TAKEN BY THE BOARD
to me his / her Community Tax Certificate No. APPROVED DISAPPROVED CONDITIONAL
2701-3065-2462-5042 202 TEBENG,
________________________issued at CITY OF DAGUPAN PANGASINAN
_______________
REMARKS ______________________________________________
on _____________.
07/26/2023 ______________________________________________________________________________
DOCUMENTARY STAMP

CHAIRMAN/ MEMBER ______________________ Date __________


____________________________________________________________
ACTION TAKEN BY THE CASHIER
_______________________________
PRC ADMINISTERING OFFICER AMOUNT PAID ____________
600.00 OFFICIAL RECEIPT NO.E2025-05-29391762
_____________
Paymaya - Gcash Payment
CASHIER _________________________________ 05/19/2025
Date __________
____________________________________________________________
ACTION TAKEN BY THE ISSUING OFFICER
Administration of Oath Is Free REMARKS _______________________________________________
(Office Order No. 2009-377 & 2009-379 ______________________________________________________________________________
both dated September 3, 2009)
ISSUING OFFICER ________________________ Date __________

IMPORTANT: FAILURE TO SUBMIT THIS APPLICATION FORM WITH THE REQUIRED DOCUMENTS SHALL MEAN APP-01
NON-INCLUSION IN THE LIST OF EXAMINEES IN THE ROOM ASSIGNMENT AND FORFEITURE OF EXAMINATION FEES Rev. 00
February 25, 2015
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