BOIS Form Revised 2022

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Republic of the Philippines

Department of the Interior and Local Government
DILG-NAPOLCOM Center, EDSA corner Quezon Avenue, Quezon City

BARANGAY OFFICIAL’S INFORMATION SHEET

● REGION VIII CITY/MUN : HINUNDAYAN

PROVINCE : SOUTHERN LEYTE BARANGAY :

ELECTIVE AND APPOINTIVE POSITION

Punong Barangay Barangay Treasurer
Sangguniang Barangay Member Barangay Secretary
Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer
SK Chairperson SK Secretary
SK Member (Rank 1, 2, 3, 4, 5, 6, 7) IPMR
Relationship with the Appointing Authority: __________________
TERM IN THE PRESENT POSITION: Other Appointive Barangay Official:
1st 2nd 3rd ___________________________________

PERSONAL INFORMATION

(PhilSys Card No.)

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

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

(Residence
Address) (Residence Telephone No.)

(Mobile Number) (Barangay Hall Telephone Number) (E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Please specify: Graduate Under Graduate

OCCUPATION: HONORARIUM:

BENEFICIARIES: (optional for the other appointive barangay officials)

NAME DATE OF BIRTH RELATIONSHIP

1.

2.

3.

4.
(Please use additional Sheet if necessary)

I hereby certify that the above information is 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.

Verified and validated by:

DENNIS C. PADOLINA Date:

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