BOIS Form 001 Revised 2017

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Republic of the Philippines ID PICTURE
Department of the Interior and Local Government
DILG-NAPOLCOM Center, EDSA corner Quezon Avenue, Quezon City

BARANGAY OFFICIAL'S INFORMATION SHEET

REGION: I MUNICIPALITY: SANTO TOMAS

PROVINCE: LA UNION BARANGAY:

ELECTIVE AND APPOINTIVE POSITIONS

Punong Barangay Barangay Treasurer

Sangguniang Barangay Member Barangay Secretary

Rank ( 1, 2, 3, 4, 5, 6, 7 ) Relationship with Appointing Authority:
SK Chairperson IPMR
SK Member other Appointed Barangay Official:
TERM IN THE PRESENT POSITION
1st 2nd 3rd

PERSONAL INFORMATION

(Last Name) (Suffix e.g. Jr., I, II, III) (First Name) (Middle Name)

(Birthdate: mm/dd/yyyy) Birthplace Sex Civil Status Religion

(Residential Address) (Residential Number)

HIGHEST EDUCATIONAL ATTAINMENT: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Please specify: Graduate Undergraduate

OCCUPATION: HONORARIUM:

BENEFICIARIES:
NAME BIRTHDATE RELATIONSHIP

1.

2.

3.

4.

5.

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

(Signature over Printed Name) (Date Accomplished)

Verified and Validated by:

JOHN ROBERT F. DIAZ

OIC-MLGOO Date