Revised

Form 2006
Republika ng Pilipinas
Lungsod ng Valenzuela

TANGGAPAN NG PUNONG LUNGSOD

OFFICE OF THE SENIOR CITIZEN AFFAIRS
PERSONAL DATA

Pangalan: ______________________________________________________________________
Apelyido Unang Pangalan Gitnang Pangalan
Kasalukuyang Tirahan:____________________________________________________________
Numero Kalye Barangay
Taong Gulang : ________Kapanganakan : _________________Lugar : _____________________
Kasarian : ____________ Katayuang Sibil : __________________ Lahi :____________________
Abot ng Pinag-Aralan : ________________________ kasanayan / Skills :_________________
Hanapbuhay : ________________________________ Kabuuang Kita sa isang Taon : _______
Numero ng Telepono : _________________________ Taglay na sakit : __________________

MEYEMBRO NG PAMILYA

Pangalan Taong Katayuang Abot ng Hanapbuhay

Gulang Sibil Pinag-Aralan
Asawa : _________________________________________________________________________
Anak : __________________________________________________________________________
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Petsa Lagda

MGA KAILANGAN
1. PICTURE - Latest Colored o Black & White, apat ( 4 ) piraso 1X1 na may lagda sa likod.
2. VOTER’S ID / VOTER’S AFFIDAVIT: 1 kopya XEROX copy
3. BIRTH CERTIFICATE or SSS ID : 1 kopya Xerox copy, para lamang ito sa may edad na 60 hanggang 63.
4. PUMUNTA NG PERSONAL SA TANGGAPAN NG OSCA ANG APLIKANTE.

PAALALA: Kung sakaling binawian na ng buhay O namatay ang SENIOR CITIZENS ID Holder, ang
Asawa O anak ay ibalik ang kanyang ID at ipagbigay alam sa OSCA sa loob ng Tatlong (3)
buwan lamang.
PDM / nmj.