Attorney'S Mcle Compliance Report: Mandatory Continuing Legal Education Office

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MCLE FORM

03
SUPREME COURT OF THE PHILIPPINES DATE:
MANDATORY CONTINUING LEGAL EDUCATION OFFICE ACTION:
4th Floor, IBP Building
Doña Julia Vargas Avenue
Ortigas Center, Pasig City

ATTORNEY’S MCLE COMPLIANCE REPORT


1. Name:

2. Mailing Address:

3. Bar Admission Roll No. e-mail address:


4. Telephone Telefax :

5. COMPLIANCE CREDIT SUMMARY:


(Please fill up form at the back)

Category of
Participation
Title of MCLE Subject Date (Attendee, Law
: : Provider: of : Lecturer, : CU
Activity/Program Area
Actvity Professor/Bar
Reviewer,
Author/Editor)
: : : : :
: : : : :
: : : : :

6. CARRYOVER CREDITS (Per Rule 12, Sec.2, Bar Matter No. 850 and Sec. 12 (d) MCLE I.R.)
This refers only to excess credit units earned during the 60-day make-up period for those who failed to complete
the MCLE requirement for the preceding compliance period.

7. EXEMPTIONS/MODIFICATIONS and Period Covered: (with application fee of P1,000.00)


REASON FOR THE EXEMPTION:

8. Completion Plan: ____ I hereby request for additional time to complete the MCLE requirement under the
MCLE Rules and Regulations. Attached is my proposed plan for completing the requirements. A non-
compliance fee of P1,000.00 is enclosed herewith.

9. Required attachments to this Application:


a) Certificate of Attendance in an accredited MCLE activity/program;
b) Program Agenda of the Activity/Program or the announcement brochures that indicate the program
details and the qualification of the faculty, if available;
c) Certificate as Law Lecturer/Professor/Bar Reviewer/and published book, newsletter or journal of the
Author or Editor; and
d) Certificates/documents pertaining to exemption or modification of MCLE requirement.

10 . I hereby affirm that the above information is accurate and complete to the best of my knowledge.

______________________________________________ ________________________
Printed Name and Signature of Applicant Date

SUBSCRIBED AND SWORN TO before me this ____day of ______________, 20__, affiant exhibiting
to me his SSS / TIN / Passport / Driver’s License No. issued on
, at .

NOTARY PUBLIC

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