Share

Application Form as Local CPD Provider

PRC chemistry application form for local continuing professional development

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Professional Regulation Commission
APPLICATION FOR ACCREDITATION AS CPD PROVIDER (LOCAL)

CPD Council of CHEMISTRY
New

Renewal

Accreditation No.
Expiry Date

Part I. Personal / Corporate Information
Name of Provider:
Classification:
Individual/Sole Proprietorship
Address:

Firm/Partnership/Corporation

Government Institution/Agency

Telephone No.:

Fax No.:

E-mail Address:

Website:

Contact Person:

Contact No.:

Part II. Acknowledgment
I HEREBY CERTIFY that the above information
written by me are true and correct to the best of my
knowledge and belief. I further authorize PRC and
other agencies to investigate the authenticity of all the
documents presented.

SUBSCRIBED AND SWORN to before me this _____
day
of
_______________
20__
at
____________________, affiant exhibited to me
his/her valid government issued ID _______________
issued at _______________ on _______________.

_____________________________
Signature Over Printed Name
_____________________________
Position
_____________________________
Date
Part III. Action Taken
Continuing Professional Development Section:
Processed by: _______________
Date
: _______________

_____________________________
(Notary Public)

Cash Division:
Amount
:______________
O.R.No./Date :______________
Issued by
:______________

Reviewed by:
____________________________________________
Chief, Regulation Division
ACTION TAKEN BY THE CPD COUNCIL
Approved
Accreditation No. __________________
Deferred pending compliance ______________________________________
______________________________________________________________
Disapproved due to ______________________________________________
______________________________________________________________
______________________________
Chairperson
____________________________
Member

____________________________
Member

Date____________________
CPDD-CHM-01-A
Rev. 00
November 22, 2017
Page 1 of 2

PROCEDURE FOR ACCREDITATION AS CPD PROVIDER (LOCAL)
Step 1. Secure Application Form at Window 15, 16, or 17 of the Registration Division, PRC-PICC, or at any of
the Regional Offices, or download at PRC website (www.prc.gov.ph).
Step 2. Fill-out Application Form and comply the required documents. (Please provide one (1) set for receiving copy)
Step 3. Proceed to Window 15, 16, or 17 of the Registration Division, PRC-PICC, or at any of the Regional Offices
for evaluation and assessment.
Step 4. Pay prescribed fee (in cash, Postal Money Order, Manager’s Check, Bank Draft payable to
Professional Regulation Commission) of Five Thousand Pesos (P 5,000.00).
Step 5. Submit Application Form with attached supporting documents and photocopy of official receipt to Window 15,
16, or 17 of the Registration Division, PRC-PICC, or at any of the Regional Offices.
Step 6. Verify your application after ___days from time of submission by calling telephone numbers:
310-10-48 (PRC-Main)/810-84-15 (PRC-PICC), or email at prc.cpdsecretariat@gmail.com
CHECKLIST OF REQUIREMENTS
SUPPORTING DOCUMENTS
Individual / Sole Proprietor
Firm / Partnership / Corporation
Government Institution/Agency
[ ] Résumé must include:
[ ] Company Profile must Include
[ ] Copy of charter or Republic
relevant Educational
Mission, Vision, Core Values and if
Act establishing the agency
background, current
any, a list of previous training
[ ] Instructional Design (one)
employment, profession,
activities conducted
[ ] Annual plan of proposed
principal area of professional
[ ] List of Officers with valid
CPD Activities
work & No. of years in the
Professional ID Card (if applicable) [ ] Office Order or its equivalent
practice of the regulated
[ ] List and photographs of
from the head of Agency
profession
training equipment and facilities
appointing its officer to manage
[ ] Valid Professional Identification
[ ] Instructional Design (one)
the CPD activities.
Card
[ ] Annual plan of proposed
[ ] Company Profile must include
CPD Activities
[ ] Appointment paper from the
Mission, Vision, Core Values
and if any, a list of previous
managing partner authorizing
training activities conducted
the partner to manage CPD
activities; or Board
[ ] List and photographs of
Resolution/Secretary
training equipment and
Certificate of a Corporation
facilities
[ ] Instructional Design (one)
authorizing an officer to
[ ] Annual plan of proposed CPD
manage CPD activities
Activities
[ ] SEC Certificate of
[ ] DTI Certificate of Registration
Registration and Articles of
(authenticated copy)
Incorporation or Partnership
[ ] NBI Clearance (original)
and their respective By-laws
[ ] BIR Certificate of Registration
(authenticated copy)
(authenticated copy)
[ ] BIR Certificate of Registration
[ ] Affidavit of Undertaking
(authenticated copy)
(CPDD-06)
[ ] Affidavit of Undertaking
(CPDD-06)

Renewal
List of CPD activities for the last 3 years
List and photographs of training equipment and facilities
Annual plan of proposed CPD Activities
General Information Sheet for Corporation or Partnership
Amended Articles of Incorporation or Partnership and their respective by-laws, if there are changes
Appointment paper from the managing partner authorizing the partner to manage CPD activities; or Board
Resolution/Secretary Certificate of a Corporation authorizing an officer to manage CPD activities; or Office Order or
its equivalent from the head of Agency appointing its officer to manage the CPD activities, if there are changes.
[ ] Affidavit of Undertaking (CPDD-06)
Additional Requirements:
[ ] Short brown envelope for the Certificate of Accreditation
[ ] One set of metered documentary stamps worth Twenty-Five Pesos (P25.00) to be affixed to the
Certificate of Accreditation. (Available at PRC Customer Service and PRC Regional Offices)
[ ] Soft copy of the Application including supporting attachments in PDF format saved in CD.
[ ] Pre-paid pouch (preferably from Philpost) for applications filed in Regional Offices only.
Note:
1. Representative/s filing application/s for accreditation and claiming the Certificate of Accreditation in behalf of the
applicant must present a letter of authorization and valid identification cards of both the authorized signatory and the
representative.
2. The period for processing the application is 60 days.
3. If additional requirement/s is/are needed, a period of 15 days is given to submit the same. Failure to comply within
the period shall be construed as abandonment of application and the prescribed fee shall be forfeited in favor of the
government.
4. The Articles of Incorporation/Partnership shall include as one of its purposes the training and development
of professionals; or in the case of commercial or industrial, provides for the training and development of its own
professionals.
[
[
[
[
[
[

]
]
]
]
]
]

CPDD-CHM-01-A
Rev. 00
November 22, 2017
Page 2 of 2
 
Page of
Share