REFERENCE NO: CEYJGD4TC8GC | OR: E2024-11-10000977 | Amount: PHP 75.
00
Nov 28, 2024 (08:00 AM TO 09:00 AM) - PRC Cagayan de Oro
NOTE: This appointment date might be different to the date of claiming of the requested authenticated documents
Professional Regulation Commission
ACTION SHEET FOR AUTHENTICATION
DATE FILED: Nov 27, 2024 Please underline: MALE/FEMALE
_______
NAME: ESPAÑO, SIERA LEE ELAINE SAGRADO
_____________________________________________________________________________________________
Last Name First Name Middle Name Married Name
PROFESSION: NURSE REGISTRATION NO.: 0807610 REGISTRATION DATE: 08/02/2013
(For Professional Teacher, please tick [ ] Elementary [ ] Secondary)
VALIDITY DATE OF PROFESSIONAL IDENTIFICATION CARD (PIC): 11/27/2028 TEL./CP NO.: 09264144568
PLEASE CHECK BOX FOR TYPE OF DOCUMENT TO BE AUTHENTICATED:
CERTIFICATE OF REGISTRATION (COR) NO. OF COPIES PURPOSE:
CERTIFICATION OF BOARD RATING NO. OF COPIES LOCAL
CERTIFICATION OF GOOD STANDING NO. OF COPIES ABROAD
CERTIFICATION OF PASSING NO. OF COPIES LEGAL
X PROFESSIONAL IDENTIFICATION CARD NO. OF COPIES 1 STATEBOARD
REPORT OF RATINGS NO. OF COPIES OTHERS
OTHERS NO. OF COPIES
FOR PRC PROCESSING
75.00
Amount: ____________________________ Processed by: Prepared by:
_
E2024-11-10000977
O. R. No.: ___________________________
11/27/2024 ___________________________________ ____________________________________
Date: ___________________________
Signature over printed name Signature over printed name
PAYMAYA-GCASH
Issued by: ___________________________
- Date: ______________________________ Date: ________________________________
Date due: __________________________
NOTE: AUTHENTICATION REQUIRES A VALID PROFESSIONAL IDENTIFICATION CARD.
AUTHENTICATION CLAIM SLIP
PLEASE FILL OUT THIS CLAIM SLIP
NAME: ESPAÑO, SIERA LEE ELAINE SAGRADO
_____________________________________ PROFESSION: NURSE
___________________________
0807610
REGISTRATION NO.: _____________________________________ 08/02/2013
REGISTRATION DATE: ___________________________
DATE FILED: Nov 27, 2024
_____________________________________ -
DATE DUE: _____________________________________
PLEASE PRESENT THIS SLIP TO CLAIM DOCUMENTS AT ______________ ON ______________________. PRC REGISTERED
REPRESENTATIVE SHOULD PRESENT ANY VALID GOVERNMENT-ISSUED ID AND AUTHORIZATION LETTER; IF NOT REGISTERED
PROFESSIONAL, PRESENT SPECIAL POWER OF ATTORNEY(SPA)AND ANY VALID GOVERNMENT-ISSUED ID.
REGISTRATION OFFICER
IMPORTANT NOTES:
1. PLEASE ENSURE THAT YOU BRING THE ORIGINAL DOCUMENT YOU
WISH TO HAVE AUTHENTICATED.
2. ADDITIONALLY, PLEASE REMEMBER TO BRING THE CORRESPONDING
NUMBER OF PHOTOCOPIES OF THE SAME DOCUMENT THAT REQUIRE
AUTHENTICATION.
PRD-07
Rev. 00
October 16, 2020
Page 1 of 2
