Académique Documents
Professionnel Documents
Culture Documents
OFFICE NAME
Authentication of Eligibility
(attach original certificate)
Certification of Eligibility
(no/lost original certificate; attach Declaration)
PERSONAL INFORMATION (Please print.)
Others
Gender:
Civil Status:
Last Name
First Name
Middle Name
Current Name:
Presently employed?
Yes
No
Company:
Current Address:
Address:
Date of Birth:
Place of Birth:
Purpose/s of Request:
Employment
Promotion
Others
Rating Obtained:
Date of Issuance/Exam:
Registration/Certificate/Card/Resolution No.:
Date of Effectivity:
Place of Issuance/Exam:
Registration/Certificate/Card/Resolution Date:
Requested By:
Signature of the Eligible/Examinee
Contact No.
Authorized Representative
(Printed Name & Signature)
(Examinee/Eligible)
Contact No.
ACTION TAKEN
CHECKED DATA AGAINST THE ML
Book No.
Page No.
Seq./Line No.
School Code/Batch No.
Examinee/Reg. No.
Date Issued/Released:
NO AVAILABLE RECORD
REMARKS
REMARKS
Name/Signature/Initials:
1st Verifier:
Date:
RELEASE OF REQUEST/S
Fee:
Not In Order
O.R. No.:
Date:
2nd Verifier:
Date:
1st Validator:
Date:
Released by
Action Officer
Signature of Eligible/Representative
(Please see Guide and Checklist of Requirements at the back page.)
Date:
Time:
4. Voter's ID
5. SSS ID
6. GSIS ID
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
} duly authenticated/validated by the Philippine
2. Copy of one (1) Identification Card.
} Embassy or Consular Office
Revised 01192011