Professional Regulation Commission

International Affairs Office

APPLICATION FORM
TEMPORARY TRAINING PERMIT FOR FOREIGN MEDICAL PRACTITIONER

Regional Office
Note: This application must be accomplished by the applicant and submitted at the Regulations Division Passport Size ID
of any PRC Regional Office. Picture of the
Applicant with
Categories Application COMPLETE NAME
Residency Training Program New Tag in plain
Fellowship Training Program Renewal (If it is within the prescribed period of the contract) white background
Extension (if it is beyond the prescribed period of the contract)
Transfer to another training program/accredited training
Institution/hospital

Part I – Personal Data

Gender Surname: Given Name: Middle Name:

Male
Female

Citizenship: Contact number and E-mail Address: Philippine Mailing Address:

Have you ever been charged or found guilty of crime involving moral turpitude, negligence, incompetence, malpractice Yes No
fraud, deceit, unprofessional, unethical, immoral or dishonorable conduct in relation to the practice of profession?

If YES, give particulars:

Do you have any condition or impairment (including history of alcohol or substance abuse) that currently interferes, Yes No
or if left untreated may interfere, with your ability to pratice in a competent and professional manner?

If YES, give particulars:

Part II – License/s Obtained

Title of License Place of Practice Issuing Agency License/ Date Issued Validity
Certification Number

Part III – Accredited Training Institution/Hospital

Name of Training Institution/Hospital: Address: Specialization: Duration of the

program (mm/dd/yyyy):

Part IV – Foreign medical professional who has completed the Residency Training Program, if applicable

Name of Training Institution/Hospital: Address: Specialization: Date Completed

(mm/dd/yyyy):

Part V – Foreign medical professional who transfers to another training program/institution/hospital, if applicable

FROM TO

Name of Training Institution/Hospital: Address: Name of Training Address:

 Institution/Hospital:

Specialization: Date Completed (mm/dd/yyyy): Specialization: Duration of the

program (mm/dd/yyyy):

Part V- Acknowledgment
I HEREBY CERTIFY that the above information supplied are true and correct to the best of my knowledge and belief, and further authorize the PRC to
investigate the authenticity of all the documents presented. Further, I agree to the PRC Privacy Notice and give my consent to the collection and processing
of my personal data in accordance thereto.

Signature over printed name of Applicant Date Accomplished

IAO-QRD-32
Rev. 01
November 11, 2019
Page 2 of 2

Assessment and Evaluation of requirements

Initial application
1. Duly accomplished Application Form (Temporary Training Permit) (The form is available at https://www.prc.gov.ph/residency-
fellowship-training-program)
2. Training Contract signed by the Medical Director or Head of the training institution/hospital (The training contract shall stipulate the
duration, terms and conditions of the training, including payment of the prescribed training fees and insurance fees (e.g. medical
malpractice insurance), as may be required by the institution/hospital. The contract shall also indicate that the foreign medical
profession shall not receive from the training hospital/institution any monetary compensation for the duration of his/her medical
residency/fellowship training therein.)
3. Letter of appointment signed by the Medical Director or Head of the training institution/hospital indicating that the foreign medical
professional has been accepted by them.
4. Photocopy of valid passport as proof of citizenship
5. Photocopy of Certificate of Passing/Certificate of Exemption from the qualifying assessment/examination

Renewal of the Temporary Training Permit

1. Compliance of numbers 1-2, 4 in the initial application excluding numbers 3 and 5
2. Photocopy of Temporary Training Permit previously issued

Extension of the Temporary Training Permit

1. Compliance of numbers 1-2, 4 in the initial application excluding numbers 3 and 5
2. Photocopy of Temporary Training Permit previously issued
3. A letter of recommendation from the training institution/hospital for the purpose of completing the required remaining training period or
for such other valid reasons.

Transfer to another training program/institution/hospital

1. Compliance of numbers 1-2, 4 in the initial application excluding number 3 and 5
2. Photocopy of Temporary Training Permit previously issued
3. A letter from the training institution/hospital informing the Board that there is a change in the training program of the foreign medical
professional and to request the Professional Regulatory Board of Medicine (Board) the issuance of another Temporary Training Permit.
Note:
All letters should be addressed to the Chairperson of the Board. The name of the Chairperson is available at https://www.prc.gov.ph/medicine.

FOR PRC PROCESSING

Step 1: Action taken by the Assessor (Regulations Division) Step 4: Action taken by the PRB of Medicine
Complete Incomplete Approved Disapproved

Assessed by : Date:

Chairperson
Reviewed by: Date:

Member Member
If incomplete, return for completion on or before:

Assessed by : Date:
Member Member

Reviewed by: Date:

Member

Step 2: Action taken by the Cashier

Remarks/Reasons:

Temporary Training Permit Fee _______________

 O.R. No.: Amount Paid:

Cashier: Date:

Step 3: Action taken by the Processor (IAO-QRD) Step 5: Action taken by the Regulations Division

IAO-QRD Ref. No. Release of Temporary Training Permit

Processed by : Date:
Released by : Date:

Received by: Date:

Approved by: ATTY. MELISA JANE B. COMAFAY Date:
Director, IAO

Note:
1. I have requested__________________________________, Liaison Officer of the _____________________________________
(Name of the Liaison Officer) (Name of the Training Institution/Hospital)
to process my application for the issuance of Temporary Training Permit.

Signature over printed name of the Foreign Medical Professional

2. Representatives filing application on behalf of the applicant must present a valid government I.D. and company I.D. from the
training institution/hospital and a letter of authorization.
IAO-QRD-32
Rev. 01
November 11, 2019
Page 2 of 2