Republic of the Philippines

National Police Commission

NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

Serial No : N/A
Badge No :
PERSONAL DATA SHEET
TIN :
Philhealth No.

Warning!

The correctness of all statements or entries made herein is subjected to verification and any
deliberate omission or distortion of information may give sufficient cause for investigation.

I. GENERAL INFORMATION
1. NAME (Last Name, First Name, Middle Name, Qualifier)

2. RANK 3. DESIGNATION 4. DATE DESIGNATED

5. UNIT/STATION/ADDRESS

6 DATE OF BIRTH 7. PLACE OF BIRTH

8. HOME ADDRESS (House No./Street/Mun./City/Province

9. SEX 10. CIVIL STATUS 11. RELIGION

[ ] Male [ ] Female [ ] Single [ ] Married
[ ] Widower
12. COLOR OF EYES 13. HEIGHT (cm.) 14. WEIGHT (kg.)

15. BLOOD TYPE 16. BUILD 17. COMPLEXION

[ ] A [ ] AB [ ] Light [ ] Medium [ ] Light [ ] Fair
[ ]B[ ]O [ ] Heavy [ ] Dark
18. COLOR OF HAIR 19. IDENTIFYING MARKS

20. LANGUAGE/DIALECT (Read/Write/Speak) 21. ETHNIC GROUP

22. NAME AND ADDRESS OF SPOUSE/NEAREST KIN

23. DEPENDENTS

Name Date of Birth Relationship

1
 II. APPOINTMENT
24. DATE OF ORIGINAL APPOINTMENT:

25. EFFECTIVE DATE OF ORIGINAL APPOINTMENT

26. DATE OF COMMISSIONSHIP 27. SOURCE OF COMMISSION

28. DATE CAD/APPOINTMENT AS OFFICER

29. DATE OF PRESENT PROMOTIONAL APPOINTMENT 30. LATEST APPOINTMENT STATUS

III. EDUCATIONAL BACKGROUND

NAME OF INCLUSIVE DEGREE

LEVEL LOCATION
SCHOOL DATE COMPLETED
Elementary
Secondary
College
Masteral

IV. POLICE/ MILITARY TRAINING SCHOLARSHIP GRANTS

COURSE CLASS
SCHOOL LOCATION INCLUSIVE DATE
TAKEN STANDING

V. CIVIL SERVICE / PRC ELIGIBILITIES

TITLE OF EXAM DATE TAKEN WHERE TAKEN RATING OBTAINED

VI. QUALIFICATIONS AND SKILLS RELEVANT TO PNP SERVICE

Qualifications and Skills Membership and Association/Civic Club

2
 VII. POLICE/ MILITARY ASSIGNMENT RECORDS

Assignment / Position Inclusive Dates Authority

VIII. PROMOTION RECORDS

Old Rank New Rank Eff Date Prom Status Authority

IX. MEDALS/AWARDS / COMMENDATIONS RECEIVED

NATURE OF AWARD DATE AWARDED AUTHORITY

X. FIREARMS RECORD

Mr/ Lic. KIND MAKE CAL SERIAL AMMO ISSUING

No. NO. UNIT

XI. PHYSICAL AND MEDICAL RECORD

DATE OF LAST PHYSICAL / MENTAL WHERE TAKEN

EXAMINATION

DATE OF LAST DENTAL EXAMINATION WHERE TAKEN

DATE OF LAST NP EXAMINATION WHERE TAKEN

3
 XII. OFFENSE DATA

OFFENSE COMMITTED AS DISPOSITION

CHARGED (State whether TYPE OF CHARGED (Exonerated, Convicted, Pending)
administrative/criminal) (State penalty if convicted)

XIII. REFERENCES

NAME ADDRESS

XIV. PLEASE COPY IN OWN HANDWRITING

“Our London business is good but Vienna and Berlin are quiet. Mr D Lord has gone to
Switzerland and I hope for goodness. He will be there for a week at 1946 Zernath St., and
then goes to Turnie and Rome to join Col. Perry.”

____________________________________________________________________________
____________________________________________________________________________

XV. CERTIFICATION

THIS IS TO CERTIFY that the answers given above are true and correct to the best of
my knowledge and belief.

Left Right
Thumbmark Thumbmark

_______________________________

SIGNATURE OVER PRINTED NAME

SUBSCRIBED AND SWORN TO before me this day of 201_

at .

_____________________________

_____________________________

_____________________________