sample oath form

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PRC REG Form No. 001 (Rev. Nov 2007)
Republic of the Philippines
Paste here
Professional Regulation Commission
your recent
Manila
PASSPORT SIZE
colored picture in
white background with
PANUNUMPA NG PROPESYONAL
complete name tag
Ako, si _____________________________________________________, ng
NAME
___________________________________________________________________________
COMPLETE ADDRESS
(Pook na Sinilangan, Bayan/Lungsod, Probinsya)
ay taimtim na nanunumpa na itataguyod ko at ipagtatanggol ang Saligang Batas ng Pilipinas, na
ako ay tunay na mananalig at tatalima rito; na susundin ko ang mga batas, mga utos na legal, at
mga atas na ipinahayag ng mga sadyang itinakdang may kapangyarihan ng Republika ng Pilipinas;
at kusa kong babalikatin ang pananagutang ito, na walang ano mang pasubali o hangaring umiwas.
Taimtim pa rin akong manunumpa na sa lahat ng panahon at pook na kinaroroonan ay
mahigpit akong manghahawakan sa mga etikal at tuntuning propesyonal ng
mga_________________________________ sa Pilipinas, at marap
NARS / NURSE
at kong gagampanan ng
(Propesyon)
buong husay sa abot ng aking makakaya ang mga tungkulin at pananagutang iniatang sa isang
itinakdang ____________________.
NARS/NURSE
(Propesyon)
Kasihan Nawa ako ng Diyos.
_______________________________
PIRMA
(Lagda)
A - _______________________
CEDULA #
_____________________
LUGAR KUNG SAAN KINUHA ____________________
DATE NANG KINUHA
(Blg. ng Sedula)
(Kinuha sa)
(Petsa)
Nilagdaan at Pinanumpaan sa harap ko ngayong ika-_________ ng _________________
taon ng ating Panginoon _______________sa _________________________, Pilipinas.
HUWAG NYO PO MUNA FILL OUT ITONG PART NA TO....
FOR PRC PROCESSING
_______________________________
ETO RIN
OK to Pay: ___________________________________
(Pinunong Tagapanumpa)
OR No.: _____________________________________
Selyo
Date Paid: ___________________________________
Dokumentaryo
WALA DIN SUSULAT DITO
_______________________________
AT ETO PA
Profession: __________________________________
(Katungkulang Opisyal)
Registration No.: ______________________________
Registration Date: _____________________________
PERSONAL DATA
Telephone/Contact Number :
Date of Examination:
Citizenship:
Date of Birth:
ETO PEDE NYO NA PO FILL-UP......
Civil Status:
Sex:
Spouse's Name/Citizenship:
Father's Name/Citizenship:
Mother's Name/Citizenship:
PLEASE FILL OUT THIS CLAIM SLIP
CLAIM SLIP
NAME:______________________________________________ PROFESSION: _________________________________
ETO PO PART WAG DIN FILL OUT
REGISTRATION NO. __________________________________ REGISTRATION DATE:___________________________
Please present this slip at Issuance Window ______________________ to claim your professional identification card on
___________________________.
(NOTE: REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT SPECIAL POWER OF ATTORNEY / AUTHORIZATION
LETTER FROM THE REGISTERED PROFESSIONAL). FOR CONFIRMATION PLEASE CALL UP (02) 736-22-48.
______________________________________________
Registration Officer

PROCEDURES
Step 1. Accomplish this Oath Form.
Step 2. Pay for two sets of metered documentary stamps (one stamped on this form and one
for the Registration Certificate) at the Customer Service Center.
Step 3. Present duly accomplished oath form (where your profession belongs, for verification
of records and assessment at Window 14, Window 19, Window 28 or at PRC Service Center,
Ever-Recto
Step 4. Pay prescribed fees at the Cashier.
Step 5. Sign in the Registry Book and receive your claim slip at:
Window 17
Window 20
Window 27
Step 6. Claim your professional ID as scheduled. Please refer to your claim slip for
further instructions.
REQUIREMENTS
1. Duly accomplished Oath Form or Panunumpa ng Propesyonal
2. Current Community Tax Certificate (cedula)
3. Two pieces passport size colored picture in white background with complete name tag
(for Oath Form and Certificate of Registration)
4. One pc. 1"x1" colored picture in white background with complete name tag
(for Registry of Professionals)
5. Two sets of metered documentary stamps (for Oath Form and Certificate of Registration)
6. One (1) short brown envelope with name and profession
New registrants should come personally to the PRC Central Office or to the nearest
Regional Office to file his/her application for registration and to affix his/her signature on the
registry book.
In case registrant is located abroad, please find below the following requirements :
1. Take the professional's oath before the Philippine Consul.
2. Special Power of Attorney notarized by the Consul.
3. Copy of passport page showing personal data.
4. Copy of passport page showing date of entry abroad.
Board Certificates shall be claimed at the Central Office or the Regional Office where
the application for the same has been filed. Representatives must present Special Power of
Attorney and appropriate identification papers.