PERSONAL INFORMATION SHEET

COMPLETE NAME (with Middle Name):

BIRTHDATE:
CITY/PROVINCE OF BIRTH:
MOBILE NUMBER:
EMAIL ADDRESS:
PRESENT ADDRESS:
PERMANENT ADDRESS (if other than Present Address):
CIVIL STATUS:
OCCUPATION:
EMPLOYER NAME:
EMPLOYER ADDRESS:
COMPANY TELEPHONE NUMBER (if available):
GROSS ANNUAL INCOME:
TIN NUMBER:
SSS NUMBER:
HEIGHT:
WEIGHT:

COMPLETE NAME PRIMARY BENEFICIARY:

BIRTHDATE (PRIMARY BENEFICIARY):
PLACE OF BIRTH (PRIMARY BENEFICIARY):

COMPLETE NAME SECONDARY BENEFICIARY:

BIRTHDATE (SECONDARY BENEFICIARY):
PLACE OF BIRTH (SECONDARY BENEFICIARY):

FAMILY MEMBERS INFORMATION:

NAME AND AGE FATHER (IF Deceased; Age at Time of Death and Reason of Death):
NAME AND AGE MOTHER (IF Deceased; Age at Time of Death and Reason of Death):
NAME(S) AND AGES OF SIBLINGS:
NAME AND BIRTHDATE of SPOUSE (IF Deceased; Age at Time of Death and Reason of De
NAME(S) AND BIRTHDATE OF CHILDREN):

QUESTIONS (ANSWERABLE BY: YES OR NO)

1. Have you been treated or examined by any physician within the past 5 YEARS? _________
2. Have you ever had X-ray, electrocardiogram,blood studies, or other diagnostic test? ________if yes; when?________
3. Are you currently receiving any treatment or taking medication of any kind? __________
4. Have you sought advice for epilipsy, nervous breakdown, or any disorder of the brain or nervous system? _________
5. Any asthma, chronic cough, spitting of blood, tuberculoses, or any lung or respiratory system disorder? _________
6. Have you sought advice for high blood pressure, chest pain, or any disease of the heart or circulatory system? __________
7. Any disease of the stomach, intestines, appendix, bowel rectum, liver or gall bladder? ___________
8. Any nephritis, kidney stone, or any disorder of the bladder or prostate? _______________
9. Any diabetes, thyroid, or endocrine disorder? ______________
10. Any disorder of the eyes, ears, nose, throat, or any athritis, rheumatism, varicose veins, or hernia of any kind? _________
11. Any cancer or a tumor or ulcer of any kind or any abnormal tissue cloth, or any other serious illness, disease or injury not

PLUS THE FOLLOWING:

1. Picture of 2 VALID IDs
2. Selfie of YOURSELF Holding one of the Valid ID (front face)
3. Signature Spicemen (Could be Digital Signature or Signature on a Piece of Bond Paper)
4. Front Page of ATM (for automatic debit arrangement, for future recurring payments)
5. Proof of Deposit Showing your ATM Account Name and Account Number (or screenshot of online banking, showing your account name
 REY CHRISTOPHER DESINGCO CASTILLO
AUG 07, 1988
CEBU CITY
'09173127352
rcdcastillo.vrc@gmail.com
P1, B29, L28, CITIHOMES, MALANANG, OPOL, MISAMIS ORIENTAL
same
MARRIED
CIVIL ENGINEER
VENRAY CONSTRUCTION CORPORATION
75-B, R. DUTERTE ST., BANAWA, CEBU CITY
'09178577196
PHP 600,000.00
'416-535-434-000
'06-3208687-4
180.34 cm
99 kg

AIZA BORBON CASTILLO

'MAR 13, 1993
PANGANTUCAN BUKIDNON

REY CHRISTOPHER BORBON CASTILLO JR.

'FEB 14, 2013
CAGAYAN DE ORO CITY

REYLAN SENO CASTILLO, 65

MERCEDES DESINGCO CASTILLO, 65
MARION KARLO DESINGCO CASTILLO, 30
AIZA BORBON CASTILLO, 28
REY CHRISTOPHER BORBON CASTILLO JR., 8
EDITH ANTOINETTE BORBON CASTILLO, 7

YEARS? _________ NO
her diagnostic test? ________if yes; when?________ NO
of any kind? __________ NO
disorder of the brain or nervous system? _________ NO
y lung or respiratory system disorder? _________ NO
ny disease of the heart or circulatory system? ___________ NO
r gall bladder? ___________ NO
ostate? _______________ NO
NO
umatism, varicose veins, or hernia of any kind? __________ NO
ue cloth, or any other serious illness, disease or injury not mentioned above?______ NO

of Bond Paper)
ng payments)
er (or screenshot of online banking, showing your account name and account number)