OSCAForm 1 Revised January 1909 OFFICE OF THE SENIOR CITIZENS AFFAIRS Province of Cavite CITY OF BACOOR: Pate txt picture here Date: ‘APPLICAT! NATIONAL ID Name: (Sumame) (First Name) (Widdle Name) Date of Birth:, Birthplace; Age: Sex: C, Status: Educational Attainment 0 = Religion: Occupation: Annual income: Other Skills: Dialect Spoken: ‘Adoress: = [No. & Name of Street) (Barangay) (Contact Number) Precinct No: Emal Adress FAMILY COMPOSITION RELATIONSHIP [AGE | CWviL STATUS | OCCUPATION | _ INCOME This sto verify tat the above-mentioned informtion is tue and correct o the best of my knowedge and baleh ‘This epplization form shall bo secured from the Office ofthe Sanicr Clizens Affairs and submit the following requirements: 4. Photocopy of Certified True Copy of Birth Certificate ised by the PSA or any valdlogal document that wil estadish the date such as SSS ID, PRC ID, Baptismal, UMID Gard, TIN Card, Postal 1D, Phihealth Card ete. 2. Barangay Captain Certificate stating thatthe appicentis permanent resident ofthe Barangay. 3. Xerox of voter's 1D oF Voter's Registration Receipt (VAR) iseued by CONELEC Bavoor or Real Proporty “Tax 1 prove that the senor a tax payer of Bacoor 4.3 pes. txt plotures (recent) fr the IDs, grocery, and medical and free movie booklet. NOTE: Personal appearance is required Signature or Thumb mar ‘Auhoraton Letter rom senior cltzen apotcant see. ie aquired in ease of nen-eppearanco Date of beued (0) (0. Number CTC No. wae] eeuedn ew Pore oer acrer, tostnew | | Aoomess | issued At