Sie sind auf Seite 1von 3

Examination Records Request Form (ERRF)

Republic of the Philippines


OFFICE NAME

(July 2009)

Date:
Time:

CIVIL SERVICE COMMISSION


REQUEST FOR EXAMINATION RECORDS
Authentication of Eligibility
(attach original certificate)

Certification of Eligibility
(for lost original certificate)
PERSONAL INFORMATION (Please print.)

Verification of
Eligibility

Others:

Name of Examinee/Eligible:

Last Name

First Name

Middle Name

Address Used at the Time of Exam:


Name Used at the Time of Exam (for Married Women):
Date of Birth:
Place of Birth:
Current/Mailing Address:
Purpose of Request:
Presently employed? (Yes or No)
If yes, specify Employer and Address:

Gender:
Civil Status:

EXAMINATION/ELIGIBILITY DATA (Please print.)


Title of Exam/Eligibility:
Date of Exam/Issuance:
Reg. No. for PD 1006/RA 1080/Other Special Laws:

Place of Exam/Issuance:
Rating Obtained:
Registration Date:

(Failure to fill up this portion shall mean denial of the request)


Requested By:
Signature of the
Examinee/Eligible
Contact No.

Signature at the Time of Exam

Authorized Representative (Printed Name and Signature)


Right Thumb Print
(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 Released:
NO AVAILABLE RECORD

CHECKED DATA AGAINST THE PSP


In Order
Not In Order
Picture/Photo
Signature
Date of Birth
SECURITY FORM NO.

REMARKS
Name/Signature/Initial of Verifiers and Validators:
1st Verifier:
2nd Verifier:
Date:
Date:

RELEASE OF REQUEST/S
Fee

O.R. No.
Date:

1st Validator:
Date:
Attested by: ___________________

Released by
Action Officer

2nd Validator:
Date:

Received by
Printed Name & Signature of Cllient

(Please see Guide and Requirements at the back page.)

Date:_______
Time:_______

GUIDE IN ACCOMPLISHING THE EXAMINATION RECORDS REQUEST FORM (ERRF)


1. Do not leave any blank unanswered in accomplishing the request form.
2. Make sure that all information you provide are true and as written in your application for examination.
3. Right thumb print are clear and without smudges.
CHECKLIST OF REQUIREMENTS
A. CERTIFICATION OF ELIGIBILITY (for lost original certificate)
1. One piece "1 inch by 1 inch" picture with name tag and signature affixed prior to having the photograph taken
* Signature must be on top of the printed name.
* The photograph should have been taken within three (3) months prior to
filing of request for Certification of Eligibility.
* Scanned, computer-generated photo/name/signature will not be accepted.
2. Properly accomplished ERRF
3. Two (2) valid Identification Cards
4. Certification fee: Php100.00 per copy
5. If through a representative or if the requesting party is abroad, please refer to additional requirements below.
B. AUTHENTICATION OF ELIGIBILITY
1. Original Certificate of Eligibility or Report of Rating
2. Properly accomplished ERRF
3. One (1) valid Identification Card (if requesting party is the examinee/eligible)
Two (2) valid Identification Cards of the examinee/eligible (if request is filed through a representative)
4. Authentication fee: Php50.00 per copy
5. If through a representative or if the requesting party is abroad, please refer to additional requirements below.
Choices for Identification Card/s:
1. Company ID
4. Voter's ID
2. Taxpayer's ID
5. SSS ID
3. Passport
6. GSIS ID

7. Driver's License
8. PRC License
9. NBT License

10. NBI Clearance


11. Police Clearance

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 Embassy or
2. Copy of one (1) Identification Card.
}
Consular Office