DILG-NBOO-ISTMS BOIS Form 2013-1B

BARANGAY OFFICIAL’S INFORMATION SHEET

1X1
(APPOINTIVE OFFICIALS) ID Picture

REGION CITY/MUN

PROVINCE BARANGAY

POSITION: Barangay Secretary Barangay Treasurer

NAME:
(Last) (First) (Middle) (Ext)

DATE OF BIRTH PLACE OF BIRTH

MM DD YYYY

SEX: MALE CIVIL STATUS: SINGLE WIDOW / ER

FEMALE MARRIED SEPARATED

HIGHEST EDUCATIONAL ATTAINMENT: ELEM HIGH SCH COLLEGE POST GRAD

Please specify: Graduate Under Graduate

OCCUPATION:

RESIDENCE ADDRESS:
House No / Street Name

CONTACT NUMBERS:

BGY. HALL TEL NO RES. TEL NO

CELLPHONE NO E-MAIL ADD

BENEFICIARIES:
NAME DATE OF BIRTH RELATIONSHIP
1.

2.

3.

4.

5.

I hereby certify that the above information are true and correct to the best of my knowledge.

Signature Over Printed Name Date Accomplished

Certified by:

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