Application Form Accreditation As Cpa In Commerce And Industry
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1
2ANNEX D
Professional Regulation Commission
APPLICATION FORM
ACCREDITATION AS CPA IN COMMERCE AND INDUSTRY
Date Filed: ____________________
Initial
Renewal
Reference No:__________________
Part I Personal Information:
Name of Applicant:
Name of Employer or Company (where the applicant is currently employed or contracted):
Complete Address of the Office:
Position in the Company or Organization:
E-Mail Address:
Tel. No.
Cell No.
Fax No.
Part II Acknowledgment:
I HEREBY CERTIFY that the above information written by me are
SUBCRIBED AND SWORN to before me this
true and correct to the best of my knowledge and belief. I further
_____________ day of _____________ 20 ____ at
authorize PRC and other agencies to investigate the authenticity
_________________, affiant Applicant exhibited to me
of all the documents presented.
his/her valid government issued ID _______________
issued at ______________ on ________________.
_____________________________
__________________
Signature of Applicant
Date:
___________________________
(Notary Public)
Part III Action Taken:
Registration Division:
Legal Division:
(Verification of License)
(Clearance of no derogatory record)
Cash Division:
Standards & Inspection Division:
Amount:
________________________________
O.R. No.
________________________________
Processed by:
Date
________________________________
____________________________
Issued by:
________________________________
Date:
____________________________
Reviewed by:
ATTY. MARIA LIZA M. HERNANDEZ
OIC, Standards & Inspection Division
ACTION BY THE BOARD OF ACCOUNTANCY
Approved
Disapproved
________________________
_______________________
Chairman
Vice Chairman
________________________
_______________________
Member
Member
________________________
_______________________
Member
Member
________________________
_______________________
Member
Member
Date:_____________________
Assigned Certificate No.: ________________________
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