BOIS Form 001 Revised 2017

1X1
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

REGION : CITY/MUN :
PROVINCE : BARANGAY :

ELECTIVE AND APPOINTIVE POSITION

Punong Barangay Barangay Treasurer Barangay Secretary
Sangguniang Barangay Member Relationship with the Appointing Authority:
Rank (1, 2, 3, 4, 5, 6, 7) IPMR
SK Chairperson SK Member other Appointive Barangay Official:
TERM IN THE PRESENT POSITION

1st2nd3rd

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:

CD/CLGOO/MLGOO Date
(Signature Over Printed Name)