Modified Personal Data Sheet for

PNPA Cadets
Republic of the Philippines
Department of the Interior and Local Government
NATIONAL POLICE COMMISSION
NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE
Camp BGen Rafael T Crame, Quezon City

2X2
Picture

POLICE DATA SHEET

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

Date Accomplished:
I. GENERAL INFORMATION
1. NAME (Last Name First Name Middle Name Qualifier)
REBURIANO MAR JOSEPH AGTUCA0
2. RANK 3. BN/COY/PLATOON/SQUAD
3RD CLASS CADET 2ND BATTALION/ DELTA COMPANY/1ST PLATOON/2ND SQUAD
4. HOME ADDRESS (Block # / Street / Barangay / City / Province)
B19 L15 ANONANG ST. VILLA KARANGAHAN SAN FELIPE NAGA CITY BICOL
5. PLACE OF BIRTH 6. DATE OF BIRTH (mm/dd/yyyy)
NAGA CITY, BICOL 04/17/2000
7. SEX 8. CIVIL STATUS 9. RELIGION
MALE SINGLE ROMAN CATHOLIC
10. COLOR OF HAIR 11. COLOR OF EYES 12. HEIGHT (cms) 13. WEIGHT (kgs)
BLACK BLACK 178 68
14. BLOOD TYPE 15. BUILD 16. COMPLEXION
O MEDIUM FAIR
17.LANGUAGES 18. IDENTIFYING MARK 19. ETHNIC GROUP
ENGLISH, TAGALOG, BICOL MOLE ON LEFT EYEBROW
20.NAME OF SPOUSE OR NEAREST KIN/ADDRESS 21. OCCUPATION
N/A PNPA CADET
22. DEPENDENTS
NAME DATE OF BIRTH RELATIONSHIP ADDRESS
(mm/dd/yyyy)

MARIO B. REBURIANO JR. 04/10/1971 FATHER -SAME-

MARICEL A. REBURIANO 04/12/1970 MOTHER -SAME-
23. HOUSING DATA

[ ] OWN HOUSE & LOT [ ] RENT HOUSE [ ] OCCUPYING GOV’T QUARTERS

[ ] OWN HOUSE ONLY [ ] RENT ROOM [ X ] OTHERS __________________

II. APPOINTMENT AND EXPERIENCE / TIG DATA
EFFECTIVE DATE OF APPOINTMENT OF EFFECTIVE DATE OF PROMOTION OF PREVIOUS RANK
PREVIOUS RANK BY CSC PER PNP SO/GO
STATUS DATE AUTHORITY STATUS DATE AUTHORITY
TEMPORARY _________ ___________ TEMPORARY ____________ ______________
PERMANENT _________________________ PERMANENT ____________ ______________

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 Modified Personal Data Sheet for
PNPA Cadets

III. EDUCATIONAL BACKGROUND

DEGREE
HONORS
LEVEL NAME OF SCHOOL LOCATION YEAR COMPLETED/
RECEIVED
UNITS
NAGA CENTRAL NAGA CITY,
ELEMENTARY 2013 GRADUATED VALEDICTORIAN
SCHOOL II BICOL
NAGA CITY
NAGA CITY, SHS W/
SECONDARY SCIENCE HIGH 2018
BICOL GRADUATE HONORS
SCHOOL
PHILIPPINE
COLLEGE NATIONAL POLICE SILANG,CAVITE
ACADEMY

IV. NAPOLCOM / CIVIL SERVICE / PRC ELIGIBILITIES

TITLE OF
DATE TAKEN WHERE TAKEN RATING OBTAINED
EXAMINATION

V. CERTIFICATION

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

I COMMIT MYSELF TO BE LIABLE for perjury and/ or dishonesty as result of any false,
misrepresentation or omission in this Police Personal Data Sheet

_____________________________
(Signature over Printed Name)

LEFT RIGHT
THUMBMARK

SUBSCRIBED AND SWORN TO before me this _____ day of ____________________, 2020

at ________________________________________, Philippine

ADMIN OFFICER
_______________________________________
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 (Signature)