Document Reference Code Document Reference Code

SDOIC-O1B2-FR-048 SDOIC-O1B2-FR-048
Document Title : CHECKLIST FOR Document Title : CHECKLIST FOR
CHANGE OF NAME AND PERSONAL DATA CHANGE OF NAME AND PERSONAL DATA
Effectivity Date Revision No. Effectivity Date Revision No.

Schools Division Office of Imus City Oct-12-2020 02 Schools Division Office of Imus City Oct-12-2020 02

NAME: CONTACT NO.: NAME: CONTACT NO.:

REQUIRED REQUIRED
REQUIREMENTS REMARKS REQUIREMENTS REMARKS
COPIES COPIES

Letter Request for change of status or correction of Letter Request for change of status or correction of
1 2 1 2
personal data (e.g. Surname, Date of Birth) personal data (e.g. Surname, Date of Birth)

2 GSIS ARA (change of status) 2 2 GSIS ARA (change of status) 2

3 Special Order for Change of Status 2 3 Special Order for Change of Status 2

Any supporting documents to support the correction Any supporting documents to support the correction
4 2 4 2
of personal data of personal data

EVALUATED BY: EVALUATED BY:

DATE: DATE:

Document Reference Code Document Reference Code

SDOIC-O1B2-FR-048 SDOIC-O1B2-FR-048
Document Title : CHECKLIST FOR Document Title : CHECKLIST FOR

CHANGE OF NAME AND PERSONAL DATA CHANGE OF NAME AND PERSONAL DATA
Effectivity Date Revision No. Effectivity Date Revision No.

Schools Division Office of Imus City Oct-12-2020 02 Schools Division Office of Imus City Oct-12-2020 02

NAME: CONTACT NO.: NAME: CONTACT NO.:

REQUIRED REQUIRED
REQUIREMENTS REMARKS REQUIREMENTS REMARKS
COPIES COPIES

Letter Request for change of status or correction of Letter Request for change of status or correction of
1 2 1 2
personal data (e.g. Surname, Date of Birth) personal data (e.g. Surname, Date of Birth)

2 GSIS ARA (change of status) 2 2 GSIS ARA (change of status) 2

3 Special Order for Change of Status 2 3 Special Order for Change of Status 2

Any supporting documents to support the correction Any supporting documents to support the correction
4 2 4 2
of personal data of personal data

EVALUATED BY: EVALUATED BY:

DATE: DATE: