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::
MARY JOY M. SUMAPID
Name of Employer or Company (where the applicant is currently employed or contracted):
E. T. DE VERA WORK ASSISTANCE AND MANAGEMENT SERVICES
Complete Address of the Office:
114 A RUBY STREET., SHINELAND VILLAGE, BARANGAY SALA, CABUYAO, LAGUNA
Certificate of Accreditation No. for Public Practice, if any:

Position in the Company or Organization: E-Mail Address:

ACCOUNTANT [email protected]
Tel. No. Cell No. Fax No.
049-3043367 09368456397 N/A
Part II Acknowledgement:
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. ________________________________ Process 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.: ________________________

QFD-SID-BOA-AFAS-05
Rev. 00
PROCEDURE FOR ACCREDITATION AS CPA IN COMMERCE AND INDUSTY PRACTICE
January 22, 2016
Page 1 of 3
 Step 1. Secure Application Form at the Standards and Inspection Division counter (Window 2)
Step 2. Fill-out Application Form
Step 3 Proceed to Registration Division for verification of License and Legal and Investigation
Division for notarization of application and to secure clearance of no derogatory
record.
Step 4. Proceed to Standards & Inspection processing window for evaluation and assessment.
Step 5. Pay the accreditation fee of P2,000.00.
Step 6. Submit Application Form with all the required documents and official receipt to the
Standards and Inspection Division designated window.
Step 7. Verify your application after _____ days from the time of submission by calling 310-
1048 (Standards & Inspection Division)
CHECKLIST OF REQUIREMENTS (Original and Photocopy)
INITIAL RENEWAL
[ ] Duly accomplished Application Form (Properly [ ] Duly accomplished Application Form (Properly
notarized and affix documentary stamp in the original notarize and affix documentary stamp in the
copy); original copy);
[ ] Sworn statement by the CPA, stating that he/she: [ ] Copy of the Expired Certificate of Accreditation;
(Please notarized and affix documentary stamp in [ ] Current National Bureau of Investigation (NBI) clearance;
the original copy) [ ] Certificate of Employment issued by the current employer;
[ ] Detailed description of work experience (data should
 Had undergone adequate and effective training (from
include name of company, position, duties and
organizations duly accredited by the Board or by its duly
responsibilities and date of employment);
authorized representatives) on all the current accounting and
[ ] Certificate of Membership in Good Standing from the
auditing standards, code of ethics, laws and their
current Accredited Integrated Professional Organization
implementing rules and regulations, circulars, memoranda
(AIPO) for the accountancy profession;
their respective codes of good governance and other related
[ ] Photocopy of current Professional Tax Receipt;
documents to ensure professional, ethical and technical
[ ] CPA Integrity Pledge;
standards;
[ ] Certificates of CPD units earned;
 Is of good moral character; and
[ ] Payment of accreditation fee in the amount of Two
 Has not been found guilty by any competent court and/or Thousand Pesos (Php2,000.00) (In Cash, Postal Money
administrative body of an offense involving moral turpitude Order, Manager’s Check or QFD-SID-BOA-AFAS-03
Bank Draft payable to the
and/or any act constituting unethical practices. Professional Regulation Commission); Rev. 00
[ ] Photocopy of current National Bureau of Investigation [ ] January
Short Brown Envelope for the Certificate of22, 2016
Accreditation
(NBI) clearance; [ ] Page 2 of 3 Pesos
One set of documentary stamp worth Twenty-One
[ ] Certificate of Employment issued by the current (Php21.00) to be affixed to the Certificate of Registration.
employer;
[ ] Detailed description of work experience (data should
include name of company, position, duties and
responsibilities and date of employment) FOR APPLICANTS WITH ACCREDITATION
[ ] Certificate of Membership in Good Standing from the IN THE PUBLIC PRACTICE:
current Accredited Integrated Professional [ ] Sworn statement by the CPA, stating that he/she: (Please
Organization (AIPO) for the accountancy profession; notarize and affix documentary stamp in the original copy)
[ ] Photocopy of current Professional Tax Receipt  Had undergone adequate and effective training (from
[ ] CPA Integrity Pledge; organizations duly accredited by the Board or by its duly
[ ] Certificates of CPD units earned; authorized representatives) on all the current accounting
and auditing standards, code of ethics, laws and their
[ ] Affidavit of Undertaking if CPD Units are
implementing rules and regulations, circulars, memoranda
insufficient at the time of filing the application; their respective codes of good governance and other related
[ ] Payment of accreditation fee in the amount of Two documents to ensure professional, ethical and technical
Note:
Thousand Pesos (Php2,000.00) (In Cash, Postal standards;
Money Order, Manager’s Check or Bank Draft  Is of good moral character; and
payable to the Professional Regulation Commission)  Has not been found guilty by any competent court and/or
[ ] Short Brown Envelope for the Certificate of administrative body of an offense involving moral turpitude
Accreditation and/or any act constituting unethical practices.
[ ] One set documentary stamp worth [ ] Certificate of Employment issued by the current employer;
Twenty-One Pesos (Php21.00) to be affixed to the [ ] Detailed description of work experience (data should
include name of company, position, duties and
Certificate of Registration. responsibilities and date of employment);
[ ] Certificate of Membership in Good Standing from the
current Accredited Integrated Professional Organization

Note:
1. Applications with incomplete documents will not be accepted. Documentary stamps are available at the PRC
customer service counters and PRC Regional Offices.
2. Representative/s filing and claiming the Certificate of Accreditation on behalf of the professional must
present Special Power of Attorney (SPA) and valid proof of identification of the professional and the
representative.
QFD-SID-BOA-AFAS-05
Rev. 00
January 22, 2016
Page 2 of 2