Professional Documents
Culture Documents
(July 2009)
Date:
Time:
Certification of Eligibility
(for lost original certificate)
PERSONAL INFORMATION (Please print.)
Verification of
Eligibility
Others:
Name of Examinee/Eligible:
Last Name
First Name
Middle Name
Gender:
Civil Status:
Place of Exam/Issuance:
Rating Obtained:
Registration Date:
Contact No.
ACTION TAKEN
CHECKED DATA AGAINST THE ML
Book No.
Page No.
Seq./Line No.
School Code/Batch No.
Examinee/Reg. No.
Date Released:
NO AVAILABLE RECORD
REMARKS
Name/Signature/Initial of Verifiers and Validators:
1st Verifier:
2nd Verifier:
Date:
Date:
RELEASE OF REQUEST/S
Fee
O.R. No.
Date:
1st Validator:
Date:
Attested by: ___________________
Released by
Action Officer
2nd Validator:
Date:
Received by
Printed Name & Signature of Cllient
Date:_______
Time:_______
7. Driver's License
8. PRC License
9. NBT License
ADDITIONAL REQUIREMENTS
A. If request for certification or authentication is filed through a Representative:
1. Authorization Letter or Special Power of Attorney (SPA); and
2. One (1) valid Identification Card of the representative.
B. If the requesting party of the certification or authentication Works/Lives Abroad:
1. Copy of Passport; and
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duly authenticated/validated by the Philippine Embassy or
2. Copy of one (1) Identification Card.
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Consular Office