MAGSASAKA PARTYLIST

“Magkakasama sa Sakahan, Kaunlaran”

E-mail: magsasakapartylist2021@gmail.com / Contact No.: 09062722809

KAALAMANG-TALA PARA SA MGA KASAPI

(Members’ Information Sheet)

BALANGAY at SANGGUNIAN: ______________________________

URI NG MAGSASAKA (Type of Farmer) (e.g. Rice Farmer or Livestock): 2X2 PICTURE
___________________________________________________________

KAALAMANG PERSONAL (Personal Information)

Buong Pangalan (Full Name) : ________________________________________ Palayaw (Nickname): _____________

Petsa ng Kapanganakan (Date of Birth): ________________________________ Edad (Age): _______________
Lugar ng Kapanganakan (Place of Birth): ________________________ Katayuang Sibil (Civil Status): ____________
Relihiyon (Religion):_________________________________ Nasyonalidad (Nationality): _______________________
Taas (Height): __________________ Timbang (Weight): _______________ Kasarian (Sex):___________________
Contact No(s): ________________________________________ E-mail:_____________________________________
Tirahan (Address): _________________________________________________________________________________
Hilig at Kakayahan (Skills/Interests): __________________________________________________________________
Pangalan ng Ama (Father’s Name): ____________________________________________________________________
Edad (Age): ____________ Hanap-buhay (Occupation): ___________________________________________________
Pangalan ng Ina (Mother’s Name): ____________________________________________________________________
Edad (Age): ____________ Hanap-buhay (Occupation): ___________________________________________________
Taong Maaring Tawagan sa Panahon ng Sakuna
(Person to be Contacted in Case of Emergency & Contact No.): ______________________________________________

PINAG-ARALAN (Educational Background)

Eskuwelahan (School) / Taong Natapos (Year Graduated)

Mababang Paaralan (Elementary):_____________________________________________________________________
Mataas na Paaralan (High School): ____________________________________________________________________
Bokasyonal na Pagsasanay (Vocational Training): ________________________________________________________
Kolehiyo (College): _________________________________________________________________________________
(Mga) Kurso Natapos at Taon (Course(s) Taken/Year): ____________________________________________________
(Mga) Kasaping Organisasyon (Organization(s) affiliated): ________________________________________________

KILALANG OPISYAL O MIYEMBRO NG PARTIDO

Pangalan (Name) Tirahan (Address) Contact No.

__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Sa pamamagitan nito, pinatutunayan ko na ang lahat ng impormasyong nakasulat dito ay totoo at tama sa abot ng
aking kaalaman. Handa akong sumunod sa lahat ng alituntunin at regulasyon ng Magsasaka Partylist. Bukod dito,
gagawin at ibabahagi ko ang lahat ng aking makakaya para sa ikabubuti at pagsulong ng Partido.

I hereby certify that all information written herein are true and correct to the best of my knowledge. I am willing to comply with all the rules and
regulations of the Magsasaka Partylist. Moreover, I will do and share all that I can for the good and advancement of the Party.

_______________________________________
Pirma at Pangalan (Signature Over Printed Name)

ID APPLICATION NO._____________
NAME: __________________________________________________________________________________________
CHAPTER: _________________ BLOOD TYPE: ____________ PRECINT NO.: _____________________________
HOME ADDRESS:________________________________CONTACT NO:.___________________________________