Examination Records Request Form (ERRF)

(July 2009)

Republic of the Philippines OFFICE NAME

CIVIL SERVICE COMMISSION REQUEST FOR EXAMINATION RECORDS

Certification of Eligibility (for lost original certificate) PERSONAL INFORMATION (Please print.)
Name of Examinee/Eligible:

Date: Time: Others:

Authentication of Eligibility (attach original certificate)

Verification of Eligibility

Last Name

First Name

Middle Name
Gender: Civil Status:

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:

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 Right Thumb Print (Examinee/Eligible) Authorized Representative (Printed Name and Signature) Contact No. CHECKED DATA AGAINST THE PSP In Order Not In Order Picture/Photo Signature Date of Birth SECURITY FORM NO. 1st Validator: Date: Attested by: ___________________ 2nd Validator: Date:

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

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

RELEASE OF REQUEST/S
Fee O.R. No. Date:

Released by
Action Officer

Received by
Printed Name & Signature of Cllient

Date:_______ Time:_______

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

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