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[]
[null,null,null,null,"             PROFESSIONAL REGULATION COMMISSION"]
[null,null,null,null,"                               Educational Statistics Division"]
[null,null,null,null,"                                                    ACTION SHEET"]
[]
[]
["Code:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Log No.:",null,null,"15-"]
[]
[null,"Institution:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Address:"]
[null,"Signatory:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Designation:"]
[null,"Date of Request:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date Received:"]
[null,"Endorsed by:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Received by:"]
[]
[]
["VERIFICATION"]
[null,null,"REQUESTED DOCUMENT/S",null,null,null,null,null,null,null,null,null,null,null,"Profession(s)",null,null,null,null,null,null,null,null,null,null,null,"Schedule(s)/Date(s)",null,null,null,null,null,"No. of pages"]
[]
[null,null,null,null,"Certification of Performance"]
[]
[null,null,null,null,"List of Examinees"]
[]
[null,null,null,null,"Research Related"]
[]
[null,null,null,null,"Others (pls. specify)"]
[]
[]
[]
[null,null,null,null,"Billing",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Payment"]
[null,null,null,null,"Amt. Billed:",null,null,null,null,null,null,null,null,null,"Date:",null,null,null,null,null,null,"Amt. Paid:",null,null,null,null,null,null,"Date Received:"]
[]
[null,null,null,null,"Mailed to:",null,null,null,null,null,null,"Institution",null,null,null,null,null,null,"R.O.",null,null,"OR No.:",null,null,null,null,null,null,"Date Paid:"]
[null,null,null,null,"No. of Documentary Stamp/s submitted:",null,null,null,null,null,null,null,null,null,null,null,null,null,"pc/s",null,null,"                           Cashier Signature"]
[]
[]
[]
[null,null,null,null,"Processing"]
[null,null,null,null,null,"List of Examinees"]
[null,null,null,null,null,"Date Started:",null,null,null,null,null,null,null,null,null,null,null,null,"Date Completed:",null,null,null,null,null,null,null,null,null,null,null,"w/ Transmittal"]
[null,null,null,null,null,"Certification of Performance"]
[null,null,null,null,null,"Date Started:",null,null,null,null,null,null,null,null,null,null,null,null,"Date Completed:"]
[]
[]
[]
[null,null,null,null,"Releasing/Mailing"]
[null,null,null,null,null,"Mailing",null,null,null,null,null,null,"Institution",null,null,null,null,null,"R.O.","Forwarded to Records Section/RCU",null,null,null,null,null,null,null,"Received by:",null,null,null,null,"Date:"]
[]
[null,null,null,null,null,"Pick-up",null,null,null,"Date:"]
[]
[]
[null,null,"REMARKS:"]
[]
[]
["\""]
[]
["CLAIM SLIP"]
[]
[null,null,"Institution:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Log No.: 15-"]
[]
[null,null,"Amount Paid:",null,null,null,null,null,null,null,null,null,null,null,"O.R. No.:",null,null,null,null,null,null,null,null,null,null,null,null,"O.R. Date.:"]
[]
[null,null,"Please present this slip to claim your requested document/s on/after :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,15,null,null,null,"working days"]
[null,null,"for inquires please call ESD at 310-0039 or email us at prc.estf@gmail.com."]
[]
[null,null,"REPRESENTATIVE WITH PROPER IDENTIFICATION SHOULD PRESENT AUTHORIZATION LETTER "]
[null,null,"FROM THE REQUESTING PARTY."]