STUDENT AY 2021-2022 / Sec:

NO. DE LA SALLE SANTIAGO ZOBEL SCHOOL

AYALA ALABANG VILLAGE, MUNTINLUPA CITY
JUNIOR HIGH SCHOOL STUDENT PERSONAL
S2012002 PROFILE

Student’s Name (In capital letters write your - Last Name, First Name, Middle Name) Birthdate
(MM/DD/YYYY)

Lim, Gerard Pio Chua 06 / 23 2007

/
Cellphone # Home Phone / Sex Religion
Landline #

8429-9849 □ Male □ Female

Catholic
Home Address

370 San Rafael St. Ayala Alabang Village, Muntinlupa City

Father’s Name (Last Name, First Name, Middle Name) Father’s Email Address

Lim, Cornelius Lizares codylim@gmail.com

Father’s Mobile # Specimen Signature 1

0917-850 0523
Father’s Office Phone # Specimen Signature 2

Mother’s Name (Last Name, First Name, Middle Name) Mother’s Email Address

Lim, Maria Elsa Chua elsa_chua_lim@yahoo.com

Mother’s Mobile # Specimen Signature 1

0917-851 0333
Mother’s Office Phone # Specimen Signature 2

Guardian’s Name / Relationship to Student Guardian’s Email Address

Guardian’s Mobile # Specimen Signature 1

Guardian’s Office Phone # Specimen Signature 2

Official MLD for School Use (just one) MLD Descriptions

□ iPad □ laptop □ android Color: Size:
tablet Brand: Serial No.
□ others Internet Provider: Mbps:

CONFORME: *We, (the student and the parent / guardian) hereby

signify that the information above are true and correct to the best of our
knowledge.
Gerard Pio C. Lim 08/11/22 Attach 2”x2” ID photo
Student’s Printed Name and Signature / Date Signed
here.

Elsa Lim 08/11/22

Parent’s/Guardian’s Printed Name and Signature / Date Signed