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Application for Fellowships - On-the-job

PNRI IAEA application form for on-the-job fellowship

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APPLICATION FOR ACCREDITATION AS CPD PROVIDER(FOREIGN)

CPD Council of CHEMISTRY
New

Renewal

Accreditation No.
Expiry Date

Part I. Personal / Corporate Information
Name of Provider:
Address:
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-B
Rev. 00
November 22, 2017
Page 1 of 2

PROCEDURE FOR ACCREDITATION AS CPD PROVIDER (FOREIGN)
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 Eight Thousand Pesos (P 8,000.00).
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
Initial
Renewal
] Company Profile (must include Mission, Vision,
[ ] List of CPD activities for the last 3 years
Core Values and if any, a list of previous training
[ ] List and photographs of training equipment
activities conducted)
and facilities
[ ] List of Officers with current Professional ID
[ ] Annual plan of proposed CPD Activities
Card (if applicable)
[ ] General Information Sheet for Corporation or
[ ] List and photographs of training equipment
Partnership or its equivalent
and facilities
[ ] Amended Articles of Incorporation or
[ ] Instructional Design (one)
Partnership and their respective by-laws or its
[ ] Annual plan of proposed CPD Activities
equivalent, if there are changes
[ ] Appointment paper from the managing partner
[ ] Appointment paper from the managing
authorizing the partner to manage CPD activities;
partner authorizing the partner to manage
or Board Resolution/Secretary Certificate of a
CPD activities; or Board Resolution/
Secretary Certificate of a Corporation
Corporation authorizing an officer to manage CPD
Activities; or its equivalent
authorizing an officer to manage CPD
activities; or its equivalent, if there are
[ ] Proof of Registration of its creation in the
country/state of the applicant which must be
changes
duly authenticated by the Philippine Embassy/
[ ] Affidavit of Undertaking (CPDD-06)
Consulate in the said country/state and
subscribed and sworn before Philippine
accompanied by an official English translation
Embassy/Consulate in the country/state of the
thereof
applicant
[ ] Affidavit of Undertaking (CPDD-06) subscribed
and sworn before Philippine Embassy/Consulate
in the country/state of the applicant
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.
[

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