NEW LIFE CHRISTIAN MISSION

4th floor Cinemar 2 Building, Magsaysay Boulevard, Calbayog City, Samar, Philippines

CHURCH GOERS INFO

Title First Name Last Name Middle Name

Gender Date Of Birth Place Of Birth

Purok No. Street Barangay City

Facebook Account Cellphone Number Network Provider

Civil Status Citizenship Weight Height Blood Type

Father's Full Name Occupation

Mother's Full Name Occupation

Spouse Name Occupation

Spiritual Birthday Person Led you To The Lord Previous Religion

First Day Of Church Attendance Date Of Water Baptism Date Spirit Baptism

FOR OFFICE ONLY

1
Date Form Filled Up Id No.

Verified By Noted

21/01/2019 5:04:56 PM 21/01/2019 5:04:57 PM

 NEW LIFE CHRISTIAN MISSION
4th floor Cinemar 2 Building, Magsaysay Boulevard, Calbayog City, Samar, Philippines

CHURCH GOERS INFO

Date Encoded To System Encoded Date Stamp Modified Date Stamp