BOIS Revised 2023

ANNEX “A”

Passport Size
Photo
Republic of the Philippines
Department of the Interior and Local Government
BARANGAY OFFICIAL’S INFORMATION SHEET
2023-2025 Term of Office

NOTE: PLEASE ACCOMPLISH THIS FORM AND WRITE LEGIBLY ALL THE INFORMATION REQUIRED IN CAPITAL LETTERS.

REGION* : 3 CITY/MUNICIPALITY* : SANTA ROSA

PROVINCE* : NUEVA ECIJA BARANGAY* : . LA FUENTE

ELECTIVE AND APPOINTIVE POSITION

(Instruction: Check the acquired position)

DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : _____________________________ DATE OF ELECTION: October 30, 2023

Punong Barangay Barangay Treasurer BADAC Cluster Leader

Sangguniang Barangay Member Barangay Secretary Barangay Health Worker
Encircle Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer Accredited/Registered by the Local Health Board
SK Chairperson SK Secretary Appointed by the Barangay (Barangay Health
Aide/Health Care Assistant)
SK Member (Encircle Rank 1, 2, 3, 4, 5, 6, 7) Barangay Nutrition Scholar
IPMR Barangay Tanod
Day Care Worker
TERM IN THE PRESENT POSITION: Accredited per ECCD Council Resolution No. 15-03
1st 2nd 3rd Appointive/Replacement dated Sept. 10, 2015
Lupon Member
VAW Desk Officer
If related with the Appointing Authority, please indicate the
degree of consanguinity/affinity: _______________________

PERSONAL AND POLITICAL INFORMATION

- - -
(PhilSys Card No.)
GENESIS ARON KEN SENDON

(Last Name) * (First Name) * (Suffix e.g. Jr., II, III) (Middle Name) *

01 -08-2004 SANTA ROSA ,NUEVA ECIJA M SINGLE CATHOLIC

(Birth Date: mm/dd/yyyy) * (Birth Place) * (Sex at Birth) * (Civil Status) * (Religion) *

PUROK 3 LA FUENTE SANTA ROSA N.E 09761528294 Aronkengenesis9@gmail.com

(Residence Address) * (Contact Number) * (Official E-mail Address)

PUROK 4 LA FUENTE SANTA ROSA N.E 09761528294 brgylafuente@gmail.com

(Barangay Hall Address) * (Barangay Hall Contact Number) * (Barangay E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT*: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Graduate ________________________ Under Graduate

(Course)
OTHER OCCUPATION,
IF ANY: HONORARIUM AS BARANGAY OFFICIAL*:
Private Government
BENEFICIARIES*: (for Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer only)

NAME DATE OF BIRTH RELATIONSHIP

(Last Name, First Name, Middle Initial) (mm/dd/yyyy)
1.

2.

3.

4.

5.
(Please use additional sheet if necessary)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
process my personal information, pursuant to the Philippine Data Privacy Act of 2012.

(Signature over Printed Name) (Date Accomplished)

Verified and validated by:

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

BOIS Revised 2023

ANNEX “A”

Passport Size
Photo
Republic of the Philippines
Department of the Interior and Local Government
BARANGAY OFFICIAL’S INFORMATION SHEET
2023-2025 Term of Office

NOTE: PLEASE ACCOMPLISH THIS FORM AND WRITE LEGIBLY ALL THE INFORMATION REQUIRED IN CAPITAL LETTERS.

REGION* : 3 CITY/MUNICIPALITY* : SANTA ROSA

PROVINCE* : NUEVA ECIJA BARANGAY* : . LA FUENTE

ELECTIVE AND APPOINTIVE POSITION

(Instruction: Check the acquired position)

DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : _____________________________ DATE OF ELECTION: October 30, 2023

Punong Barangay Barangay Treasurer BADAC Cluster Leader

Sangguniang Barangay Member Barangay Secretary Barangay Health Worker
Encircle Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer Accredited/Registered by the Local Health Board
SK Chairperson SK Secretary Appointed by the Barangay (Barangay Health
Aide/Health Care Assistant)
SK Member (Encircle Rank 1, 2, 3, 4, 5, 6, 7) Barangay Nutrition Scholar
IPMR Barangay Tanod
Day Care Worker
TERM IN THE PRESENT POSITION: Accredited per ECCD Council Resolution No. 15-03
1st 2nd 3rd Appointive/Replacement dated Sept. 10, 2015
Lupon Member
VAW Desk Officer
If related with the Appointing Authority, please indicate the
degree of consanguinity/affinity: _______________________

PERSONAL AND POLITICAL INFORMATION

- - -
(PhilSys Card No.)
BUENAVENTURA MICHAEL SAULO

(Last Name) * (First Name) * (Suffix e.g. Jr., II, III) (Middle Name) *

05- 08- 1976 SAN ISIDRO N.E. M MARRIED CATHOLIC

(Birth Date: mm/dd/yyyy) * (Birth Place) * (Sex at Birth) * (Civil Status) * (Religion) *

PUROK 5 LA FUENTE SANTA ROSA N.E 09068643796

(Residence Address) * (Contact Number) * (Official E-mail Address)

PUROK 4 LA FUENTE SANTA ROSA N.E 09534724996 brgylafuente@gmail.com

(Barangay Hall Address) * (Barangay Hall Contact Number) * (Barangay E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT*: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Graduate ________________________ Under Graduate

(Course)
OTHER OCCUPATION,
IF ANY: HONORARIUM AS BARANGAY OFFICIAL*:
Private Government
BENEFICIARIES*: (for Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer only)

NAME DATE OF BIRTH RELATIONSHIP

(Last Name, First Name, Middle Initial) (mm/dd/yyyy)
1.

2.

3.

4.

5.
(Please use additional sheet if necessary)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
process my personal information, pursuant to the Philippine Data Privacy Act of 2012.
 (Signature over Printed Name) (Date Accomplished)
Verified and validated by:

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

BOIS Revised 2023

ANNEX “A”

Passport Size
Photo
Republic of the Philippines
Department of the Interior and Local Government
BARANGAY OFFICIAL’S INFORMATION SHEET
2023-2025 Term of Office

NOTE: PLEASE ACCOMPLISH THIS FORM AND WRITE LEGIBLY ALL THE INFORMATION REQUIRED IN CAPITAL LETTERS.

REGION* : 3 CITY/MUNICIPALITY* : SANTA ROSA

PROVINCE* : NUEVA ECIJA BARANGAY* : . LA FUENTE

ELECTIVE AND APPOINTIVE POSITION

(Instruction: Check the acquired position)

DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : _____________________________ DATE OF ELECTION: October 30, 2023

Punong Barangay Barangay Treasurer BADAC Cluster Leader

Sangguniang Barangay Member Barangay Secretary Barangay Health Worker
Encircle Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer Accredited/Registered by the Local Health Board
SK Chairperson SK Secretary Appointed by the Barangay (Barangay Health
Aide/Health Care Assistant)
SK Member (Encircle Rank 1, 2, 3, 4, 5, 6, 7) Barangay Nutrition Scholar
IPMR Barangay Tanod
Day Care Worker
TERM IN THE PRESENT POSITION: Accredited per ECCD Council Resolution No. 15-03
1st 2nd 3rd Appointive/Replacement dated Sept. 10, 2015
Lupon Member
VAW Desk Officer
If related with the Appointing Authority, please indicate the
degree of consanguinity/affinity: _______________________

PERSONAL AND POLITICAL INFORMATION

- - -
(PhilSys Card No.)
DE LARA ANASTACIO MANUBAY

(Last Name) * (First Name) * (Suffix e.g. Jr., II, III) (Middle Name) *

01-22-1958 SANTA ROSA M MARRIED CATHOLIC

(Birth Date: mm/dd/yyyy) * (Birth Place) * (Sex at Birth) * (Civil Status) * (Religion) *

PUROK 4 LA FUENTE SANTA ROSA N.E 09551985315

(Residence Address) * (Contact Number) * (Official E-mail Address)

PUROK 4 LA FUENTE SANTA ROSA N.E 09534724996 brgylafuente@gmail.com

(Barangay Hall Address) * (Barangay Hall Contact Number) * (Barangay E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT*: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Graduate ________________________ Under Graduate

(Course)
OTHER OCCUPATION,
IF ANY: HONORARIUM AS BARANGAY OFFICIAL*:
Private Government
BENEFICIARIES*: (for Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer only)

NAME DATE OF BIRTH RELATIONSHIP

(Last Name, First Name, Middle Initial) (mm/dd/yyyy)
1.

2.

3.

4.

5.
 (Please use additional sheet if necessary)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
process my personal information, pursuant to the Philippine Data Privacy Act of 2012.

(Signature over Printed Name) (Date Accomplished)

Verified and validated by:

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

BOIS Revised 2023

ANNEX “A”

Passport Size
Photo
Republic of the Philippines
Department of the Interior and Local Government
BARANGAY OFFICIAL’S INFORMATION SHEET
2023-2025 Term of Office

NOTE: PLEASE ACCOMPLISH THIS FORM AND WRITE LEGIBLY ALL THE INFORMATION REQUIRED IN CAPITAL LETTERS.

REGION* : 3 CITY/MUNICIPALITY* : SANTA ROSA

PROVINCE* : NUEVA ECIJA BARANGAY* : . LA FUENTE

ELECTIVE AND APPOINTIVE POSITION

(Instruction: Check the acquired position)

DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : _____________________________ DATE OF ELECTION: October 30, 2023

Punong Barangay Barangay Treasurer BADAC Cluster Leader

Sangguniang Barangay Member Barangay Secretary Barangay Health Worker
Encircle Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer Accredited/Registered by the Local Health Board
SK Chairperson SK Secretary Appointed by the Barangay (Barangay Health
Aide/Health Care Assistant)
SK Member (Encircle Rank 1, 2, 3, 4, 5, 6, 7) Barangay Nutrition Scholar
IPMR Barangay Tanod
Day Care Worker
TERM IN THE PRESENT POSITION: Accredited per ECCD Council Resolution No. 15-03
1st 2nd 3rd Appointive/Replacement dated Sept. 10, 2015
Lupon Member
VAW Desk Officer
If related with the Appointing Authority, please indicate the
degree of consanguinity/affinity: _______________________

PERSONAL AND POLITICAL INFORMATION

- - -
(PhilSys Card No.)
GENESIS MARIVIC SENDON

(Last Name) * (First Name) * (Suffix e.g. Jr., II, III) (Middle Name) *

05 -29 -1969 CABANATUAN CITY F MARRIED CATHOLIC

(Birth Date: mm/dd/yyyy) * (Birth Place) * (Sex at Birth) * (Civil Status) * (Religion) *

PUROK 3 LA FUENTE SANTA ROSA N.E 09152176449

(Residence Address) * (Contact Number) * (Official E-mail Address)

PUROK 4 LA FUENTE SANTA ROSA N.E 09534724996 brgylafuente@gmail.com

(Barangay Hall Address) * (Barangay Hall Contact Number) * (Barangay E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT*: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Graduate ________________________ Under Graduate

(Course)
OTHER OCCUPATION,
IF ANY: HONORARIUM AS BARANGAY OFFICIAL*:
Private Government
BENEFICIARIES*: (for Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer only)

NAME DATE OF BIRTH RELATIONSHIP

(Last Name, First Name, Middle Initial) (mm/dd/yyyy)
1.
 2.

3.

4.

5.
(Please use additional sheet if necessary)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
process my personal information, pursuant to the Philippine Data Privacy Act of 2012.

(Signature over Printed Name) (Date Accomplished)

Verified and validated by:

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

BOIS Revised 2023

ANNEX “A”

Passport Size
Photo
Republic of the Philippines
Department of the Interior and Local Government
BARANGAY OFFICIAL’S INFORMATION SHEET
2023-2025 Term of Office

NOTE: PLEASE ACCOMPLISH THIS FORM AND WRITE LEGIBLY ALL THE INFORMATION REQUIRED IN CAPITAL LETTERS.

REGION* : 3 CITY/MUNICIPALITY* : SANTA ROSA

PROVINCE* : NUEVA ECIJA BARANGAY* : . LA FUENTE

ELECTIVE AND APPOINTIVE POSITION

(Instruction: Check the acquired position)

DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : _____________________________ DATE OF ELECTION: October 30, 2023

Punong Barangay Barangay Treasurer BADAC Cluster Leader

Sangguniang Barangay Member Barangay Secretary Barangay Health Worker
Encircle Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer Accredited/Registered by the Local Health Board
SK Chairperson SK Secretary Appointed by the Barangay (Barangay Health
Aide/Health Care Assistant)
SK Member (Encircle Rank 1, 2, 3, 4, 5, 6, 7) Barangay Nutrition Scholar
IPMR Barangay Tanod
Day Care Worker
TERM IN THE PRESENT POSITION: Accredited per ECCD Council Resolution No. 15-03
1st 2nd 3rd Appointive/Replacement dated Sept. 10, 2015
Lupon Member
VAW Desk Officer
If related with the Appointing Authority, please indicate the
degree of consanguinity/affinity: _______________________

PERSONAL AND POLITICAL INFORMATION

- - -
(PhilSys Card No.)
MARZO DOMINGO BIGLANG - AWA

(Last Name) * (First Name) * (Suffix e.g. Jr., II, III) (Middle Name) *

01 -21-1979 SANTA ROSA NUEVA ECIJA M MARRIED CATHOLIC

(Birth Date: mm/dd/yyyy) * (Birth Place) * (Sex at Birth) * (Civil Status) * (Religion) *

PUROK 3LA FUENTE SANTA ROSA N.E 09754094780

(Residence Address) * (Contact Number) * (Official E-mail Address)

PUROK 4 LA FUENTE SANTA ROSA N.E 09534724996 brgylafuente@gmail.com

(Barangay Hall Address) * (Barangay Hall Contact Number) * (Barangay E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT*: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Graduate ________________________ Under Graduate

(Course)
OTHER OCCUPATION,
IF ANY: HONORARIUM AS BARANGAY OFFICIAL*:
Private Government
BENEFICIARIES*: (for Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer only)
 NAME DATE OF BIRTH RELATIONSHIP
(Last Name, First Name, Middle Initial) (mm/dd/yyyy)
1.

2.

3.

4.

5.
(Please use additional sheet if necessary)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
process my personal information, pursuant to the Philippine Data Privacy Act of 2012.

(Signature over Printed Name) (Date Accomplished)

Verified and validated by:

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