CONFIDENTIAL

CAA PERSONAL HISTORY STATEMENT

INSTRUCTIONS

1. Answer all questions completely; if question is not applicable, write “NA”. Write “UNKNOWN” only if you do not know the
answer and cannot obtain the answer from personal records. Use the blank pages at the back of this form for extra details on
any question for which you do not have sufficient space.
2. Type, print, or write; illegible or incomplete forms will not receive consideration.
______________________________________________________________________________________

I. PERSONAL DETAILS
A. NAME: ______MARVEN__________CABILIDA ___________SAURA___________________
(First Name) (Middle Name) (Last Name) (Suffix)

B. SERIAL NUMBER:_LN-GI2-000162_________________________________________________

C. PRESENT ASSIGNMENT:
a. Platoon: _1st ______
b. CAA Company: _5th __LN_________
c. Cadre Company: __DELTA ______
d. Cadre Battalion: _51B___1ID PA__
e. Infantry Division: _1ID__________________

D. DUTY ADDRESS:_BRGY PAGAYAWAN BOCOLOD LANAO DEL NORTE_____________ ________

E. HOME ADDRESS (Include street number):PUROK -1 MATE BACOLOD L.D.N________________
___ LANAO DEL NORTE__________________________________________________________
F. BIRTHDATE: _06-21-87__________BIRTH PLACE: __LINAMOM LANAO DEL NORTE__________
G. NICKNAME/S:_LANDO_________ ____________________________________________________
H. TAX PAYER IDENTIFICATION NR (TIN):_____________ PHILHEALTH NR: ______________________
I. CONTACT NO.____________________ ________________________________________________
J. DECLARED BENEFECIARY:
a. Full name: _RENIE MAE INTONG SAURA__ ________________________________
b. Relationship: _WIFE______________________________________________________
c. Address: _P-1 MATE ,BACOLOD , L.D.N __________________________
d. Contact No. ______________________________________________________________
II. PERSONAL CHARACTERISTICS:
A. DESCRIPTION: Sex:__MALE______ Age:_32_____ Height: _5’5___ Weight:___75 ____
Build( Heavy, Medium, Light) : _MEDIUM_____________ Blood Type: __’A’_____________
Complexion (Dark, Brown, Light): _BROWN_________ Color of Eues:__BROWN ___________
Color of Hair: __BLACK_________ Scars or Marks & Other Distinguishing Features:___________
_______________________ Religion:_FULL GOSPHELL _____ Ethnic Group: _______________

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III. TARIFF SIZES:
Philpart BDU: _ MEDIUM __ Short Pants: LARGE____
Head Gear: _57________ Combat Boots: _7 1/2__
T- Shirt: _MEDIUM________ Rubber Shoes: _8 1/2___
IV. MARITAL HISTORY:
A. MARITAL STATUS: _____________________SEPARATED_____________________________________
(Single, Married, Separated or Widowed)

B. NAME OF SPOUSE: ___RENIE MAE INTONG SAURA____________________ ___________

( Maiden Name)

Date & Place of Marriage: __________________ _________________________________________

Date of Birth:_JULY 15 1991_________ Place of Birth:_ P1 MATE BACOLOD L.D.N____________

Occupation/ Employer/ Place of Employment: ____________________ _____________________

___________________________________________________________________________________

Contact Number:____________________________________________________________________

C. CHILDREN:
Name Date of Birth
MC RAYUIN SUARA JAN 9 2010
ANGLE SAURA MARCH 9 2018

( Use separate sheet for additional Information)

V. FAMILY HISTORY AND INFORMATION:

A. FATHER: _ ____________DOMINADOR GIDARO SAURA _____________________________

(Full Name)
Complete Address: _ROBUCON LONAMOM LANAO DEL NORTE____________________________
Contact No. _____________________________________________________________________

B. MOTHER:__________________MARILOU CABILIDA SUARA ___________________________

(Maiden Name)

Complete Address: _ P1 MATE BACOLOD LANAO DEL NORTE_________________________________

Contact No:_______________ _________________________________________________________

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 C. BROTHERS AND SISTERS:
Name: Date of Birth Address
MICHAEL C. SAURA SEPT 15 1985 P1 MATE BACOLOD L.D.N
DAISY C. SAURA DEC 16 1990 .P1 MATE BACOLOD L.D.N
DASHMAE C. SAURA APRIL 15 1995 P1 MATE BACOLOD L.D.N

(Use separate Sheet for additional information)

VI. EDUCATIONAL BACK GROUND:

A. CIVILIAN:
Name of School Level Date Graduated
LAUBACH INSTATETUTE HIGH SCHOOL 2005-2006

(Use separate Sheet for additional information)

B. MILITARY:
Training / seminar / Course Date Graduated
2012 -2013

(Use separate Sheet for additional information)

VII. ISSUANCES RECEIVED:

Particulars Quantity Date Received

(Use separate Sheet for additional information)

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VIII. GENERAL REPUTATION:
A. Give five ( 5) character references (known three years or longer, who are not your relatives):
Name Occupation Address
LORENZO INTONG BRGY CAPTAIN P-1 MATE BACOLOD L.DN
JOEL BUCOL BRGY KAGAWAD P-1 MATE BACOLOD L.DN
TOTO BONGO BUSINEES MAN P-1 MATE BACOLOD L.DN
PREDO LOOD FARMER P-1 MATE BACOLOD L.DN
ABREPINO GABIN FARMER P-1 MATE BACOLOD L.DN

IX. ORGANIZATIONS :
Organizations Address Date of membership Position Held

(Use separate Sheet for additional information)

IX. ARREST RECORD AND CONDUCT:

A. Have you ever been investigated/ arrested, indicated or convicted for any violation of
law? Yes ( ) No ( ), if so, state name of court, nature of offense and disposition of case.

Name of Court Nature of offense Disposition of Case

(Use separate Sheet for additional information)

B. Has any number of your immediate family been investigated/ arrested, indicated or convicted for any
violation of law? Yes ( ) No ( ), if so, state name of court, Nature of offense and Disposition of case.

Name of Court Nature of Offense Disposition of Case

(Use separate Sheet for additional information)

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SKETCH OF THE LOCATION OF RESIDENCE

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