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REPRODUCTION IS ALLOWED Republic of the Philippines PRC-BRO Reg. Form No. 3 (Rev. 12/3/15)
ID CLAIM SLIP
PLEASE FILL THIS PORTION ISSUED BY: Date
NAME: AMOUNT PAID:
PROFESSION: OFFICIAL RECEIPT NO.:
REGISTRATION NO.: DATE PAID:
APPLICATION TYPE: ORIGINAL ID DUPLICATE REPRINT CHANGE OF NAME
To check if your PIC is ready for release, visit www.prcbaguio.blogspot.com for PIC availability (PICAV) or call/text 09277880145 or email us at
prcbaguio.releasing@gmail.com. To claim your PIC, present this slip at Counter 14. Representative shall present this claim slip, valid ID of the representative and
authorization letter from the Professional. For schedule of mobile processing visit our website (www.prcbaguio.blogspot.com).
ID CLAIM SLIP
PLEASE FILL THIS PORTION ISSUED BY: Date
NAME: AMOUNT PAID:
PROFESSION: OFFICIAL RECEIPT NO.:
REGISTRATION NO.: DATE PAID:
APPLICATION TYPE: ORIGINAL ID DUPLICATE REPRINT CHANGE OF NAME
To check if your PIC is ready for release, visit www.prcbaguio.blogspot.com for PIC availability (PICAV) or call/text 09277880145 or email us at
prcbaguio.releasing@gmail.com. To claim your PIC, present this slip at Counter 14. Representative shall present this claim slip, valid ID of the representative and
authorization letter from the Professional. For schedule of mobile processing visit our website (www.prcbaguio.blogspot.com).
CITIZENS CHARTER REQUIREMENTS
1. Duly accomplished Form.
2. One (1) copy RECENT passport-size colored picture in white background with complete nametag (Last Name, First Name and Middle Name).
3. One photocopy of latest Professional Identification Card
4. In case of loss of unexpired Professional Identification Card, submit duly notarized Affidavit of Loss.
5. Marriage certificate from PSA/NSO (in security paper) for married female applicants who wish to apply for change of name due to marriage.
6. For Petition for correction of name and/or date of birth applicant submits copy of birth certificate from PSA/NSO in security paper (and PSA/NSO marriage
certificate for female married applicant) and duly notarized affidavit of explanation regarding request of correction;
7. Certificate of membership or official receipt issued by accredited professional organization as prescribed by respective boards(please refer below);
8. If the professional is abroad, he/she may renew his/her Professional Identification Card through representative.
NOTE: For change of registered name due to marriage and/or correction of entries, proceed to Counter 9 and submit renewal/petition form, photocopy of
Professional Identification Card, 1 passport size picture, and original PSA(formerly NSO) marriage certificate (for married female applicants only). Receive your ID
Claim and Acknowledgement Slip from the Renewal Officer.
As authorized representative, I hereby assume direct and full responsibility/liability for the professional ID card released to me.
________________________________________________________________
Signature over Printed Name of REPRESENTATIVE
NOTE: For change of registered name due to marriage and/or correction of entries, proceed to Counter 9 and submit renewal/petition form, photocopy of
Professional Identification Card, and 1 passport size picture, and original PSA(formerly NSO) marriage certificate (for married female applicants only). Receive
your Claim and Acknowledgement Slips from the Renewal Officer.
As the authorized representative, I hereby assume direct and full responsibility/liability for the professional ID card released to me.
________________________________________________________________
Signature over Printed Name of REPRESENTATIVE