ANNEX “A”

BOIS Form Revised 2020

1X1
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 : VI ___________ CITY/MUN : TIGBAUAN

PROVINCE : ILOILO BARANGAY : POBLACION 8

ELECTIVE AND APPOINTIVE POSITION

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

NAME DATE OF BIRTH RELATIONSHIP

1.

2.

3.

4.
(Please use additional Sheet if necessary)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
process my personal information, pursuant to the Philippine Data Privacy Act of 2012.

(Signature over Printed Name) (Date Accomplished)

Verified and validated by:

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