BOIS Form 001 Revised 2018

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

BARANGAY OFFICIAL’S INFORMATION

SHEET
Batangas City
REGION : IV-A (CALABARZON) CITY/MUN :
:
Bilogo
PROVINCE : BATANGAS BARANGAY

ELECTIVE AND APPOINTIVE POSITION

Punong Barangay Barangay Treasurer

Sangguniang Barangay Member Barangay Secretary
Rank (1, 2, 3, 4, 5, 6, 7) Relationship with the Appointing Authority:

SK Chairperson IPMR
SK Member other Appointive Barangay Official:
Rank (1, 2, 3, 4, 5, 6, 7)

TERM IN THE PRESENT POSITION

1st 2nd 3rd

PERSONAL INFORMATION

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

(Birth Date: mm/dd/yyyy) (Birth Place) (Sex) (Civil Status) (Religion)

(Residence Address) (Residence Telephone No.)

(Mobile Number) (Barangay Hall Telephone Number) (E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT:

ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Please specify: /
Graduate Under Graduate

OCCUPATION: HONORARIUM:

BENEFICIARIES:
NAME DATE OF BIRTH 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:

ESTHER B.DATOR
CLGOO Date