DILG-NBOO-ISTMS-BOIS-Form 2013A

BARANGAY OFFICIAL'S INFORMATION SHEET 1 X 1

(APPOINTIVE OFFICIALS) ID Picture

REGION: NCR CITY/MUN.: MANILA

PROVINCE: Metro Manila BARANGAY: 754, ZONE 81

POSITION: ✓ Barangay Secretary Barangay Treasurer

PERSONAL INFORMATION

NAME: D E L A C R U Z R O G E L I O M E N D O Z A J R
(LAST) (FIRST) (Middle) (Ext)
DATE OF BIRTH 0 3 2 6 6 9 PLACE OF BIRTH: MANILA
MM DD YYYY
SEX ✓ MALE CIVIL STATUS: SINGLE WIDOW/ER LIVE-IN

FEMALE ✓ MARRIED SEPARATED OTHERS

HIGHEST EDUCATIONAL ATTAINMENT: ELEM HIGH SCH ✓ COLLEGE POST GRAD

Please specify:
Graduate ✓ Under Graduate

OCCUPATION: NONE

RESIDENCE ADDRESS: 2389 ARELLANO AVENUE, MALATE, MANILA

House No. / Street Name
CONTACT NUMBERS:
BRGY. HALL TEL. NO. RES. TEL NO

CELLPHONE NO. 0 9 4 7 9 7 7 7 9 3 5 E-MAIL ADD.: regortess86@g. mail.com

BENEFICIARIES: DATE OF BIRTH RELATIONSHIP

1 MARITES S. DELA CRUZ April 11, 1971 SPOUSE
2 JHOMAR S. DELA CRUZ DEC. 8, 1993 SON
3 ARJAIE S. DELA CRUZ NOV. 22, 1995 SON
4 TINA DAVID S. DELA CRUZ SEPT. 12, 2001 DAUGHTER

I hereby certify that the above information are true and correct to the best of my knowledge.

ROGELIO M. DELA CRUZ JR. FEB. 14, 2018

Signature over printed name Date Accomplished
Certified by:

CD/CLGO/MLGOO Signature over printed name Date