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:_______ . 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. Choices for Identification Card/s: 1. If the requesting party of the certification or authentication Works/Lives Abroad: 1.GUIDE IN ACCOMPLISHING THE EXAMINATION RECORDS REQUEST FORM (ERRF) 1. Copy of one (1) Identification Card. CHECKLIST OF REQUIREMENTS A. GSIS ID 7. please refer to additional requirements below. Make sure that all information you provide are true and as written in your application for examination. One (1) valid Identification Card of the representative. Right thumb print are clear and without smudges.00 per copy 5. Taxpayer's ID 5. Two (2) valid Identification Cards 4. NBI Clearance 11. Authorization Letter or Special Power of Attorney (SPA). and 2. 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. Original Certificate of Eligibility or Report of Rating 2. If through a representative or if the requesting party is abroad. Authentication fee: Php50. 2. Properly accomplished ERRF 3. Certification fee: Php100. computer-generated photo/name/signature will not be accepted.00 per copy 5. If request for certification or authentication is filed through a Representative: 1. 2. NBT License 10. Copy of Passport. * The photograph should have been taken within three (3) months prior to filing of request for Certification of Eligibility. Police Clearance ADDITIONAL REQUIREMENTS A. } Consular Office . Driver's License 8. please refer to additional requirements below. Properly accomplished ERRF 3. Voter's ID 2. PRC License 9. Company ID 4. B. AUTHENTICATION OF ELIGIBILITY 1. Do not leave any blank unanswered in accomplishing the request form. If through a representative or if the requesting party is abroad. 3. Passport 6. B. * Scanned. SSS ID 3. and } duly authenticated/validated by the Philippine Embassy or 2. CERTIFICATION OF ELIGIBILITY (for lost original certificate) 1.