1x4 Repub of the Prpanes, 10 Picture Depertment of he Intesor and Loca! Government BARANGAY OFFICIAL’S INFORMATION SHEET REGION CITYMUNICIPALITY PROVINCE pee eee BARANGAY ELECTIVE AND APPOINTIVE POSITION (Instruction: Check the acquired position) (Z Punong Barangay Barangay Treasurer Sangguniang Barangay Member Lo Barangay Secretary Encircle Rank (1, 2. 3, 4,567) CO sk Treasurer Tsk chairperson Osx secretary sk Member (Enovete Rank 1.2.3.45.67 C1 IPMR ‘Relavonship wh the Apposting Autnorty — TERM IN THE PRESENT POSITION: other appointive Barangay Official: Or Oe Os T Barangay Heath Worker check tho apcicabie box [__] AccrecteciRecistered by tre Lacel Heath Board [JAppointed by the Barangay EEE PERSONAL INFORMATION presys care Na) (em ome manny) Tae aT ‘aaraay Ta Taaahone aaa evar asa icnesteoucanionaLarranwent: [CJetewentary [J worscnoo. [] couece [F] rosreran [7] vocanona. Pease soecty — []oracuste —— [] Uncer Gracvate JOcCUPATION HONORARIUM AS BARANGAY OFFICIAL BENEFICIARIES: or Purony Garena. Senopuniong Barangay Meroe, SK Cnorperson 1PM Barangay Seceay, and Barangay Tease? ‘NAME DATE OF BIRTH RELATIONSHIP 1 2 3 Pina Ta RETROFIT TORT TCRTATT | hereby certify that the above information are tue and corect to the best of my knowledge. | understand that fr the DILG to cary out its mandate they must necassarly process my personal formation. Thereloro | grant my consent shd recoprze tho autorty at the DILG to Process my personal miormation, pursuert tothe Priippine Data Prvacy Act of 2012 (Signature over Printed Name) (Bate Accompished) Verified and validated by: corc.soamugoo ate cogpaten oe Prae Rme)ANNEX “B” GUIDE IN FILLING OUT THE BARANGAY OFFICIAL’S INFORMATION SHEET (BOIS) FOR ELECTIVE AND APPOINTIVE BARANGAY OFFICIALS The BOIS must be accomplished by all elective and appointive barangay officials upon assumption to office, to be collected by the DILG City and Municipal field officers. NOTE: + Supply the entries using BLACK INK balipen only. Also, a soft copy may be accomplished electronically and must be printed using BLACK INK only. + All information should be provided accurately, as it will be the permanent record in the Barangay Officials’ Profile. Thus, itis the responsibilty of the barangay official's to provide an updated copy of BOIS, for any amendment. REGION "| Indicate the name of region. PROVINCE Indicate the name of province. CITY/MUNICIPALITY —_| Indicate the name of city/municipality. BARANGAY indicate the name of barangay. Check the acquired position (Punong Barangay, Sanguniang Barangay Member, SK Chairperson, SK member, Barangay Treasurer, Barangay Secretary, SK Treasurer, SK Secretary, IPMR and other appointive barangay officials i.e. Tanod, Lupon, BHW, BNS, Daycare Workers, VAW Desk Officers, BADAC Cluster Leaders) NOTE: + Encircle the Rank of the Sangguniang Barangay and SK Members; and «Check the term in the present position whether First, ‘Second or Third for the Punong Barangay, Sangguniang Barangay Member, SK Chairperson and SK members. «For Barangay Health Workers (BHWS). indicate if Accredited/Registered by the Local Health Board or Appointed by the Barangay. POSITION PERSONAL INFORMATION: This part of the BOIS contains the basic information of the elective and appointive barangay offcial/s. The information provided herein are important for the generation of Barangay Officials’ Profile, and as basis for the issuance of Certification of Eligibility by the Civil Service ‘Commission and other benefits enumerated pursuant to Section 393 of the LG Code of 1991 or RA 7160. PHILSYS CARD NUMBER Indicate the 16-digit PhilSys Card Number indicated in the PhilSys ID | LAST NAME Indicate the Last Name of the Barangay Official | | ‘SUFFIX indicate the Suffix (any) of the Barangay Official (e.9. Jr. uN)FIRST NAME Given Name of the Barangay Official MIDDLE NAME Middle Name of the Barangay Official BIRTH DATE ~~ | Complete Birth date (MMIDD/YYYY) BIRTH PLACE City/Municipality and Province of birth SEX AT BIRTH | M for Male, F for Female | CIVIL STATUS ~~) $ “Single; M-Married; W-Widow/Widower; ‘'SP-Separated RELIGION Indicate whether Roman Catholic, INC, or others. RESIDENCE ADDRESS Indicate the complete Residence Address RESIDENCE TELEPHONE indicate the Residential Telephone No. (jfany) NUMBER MOBILE NUMBER: Indicate the Personal Mobile No. BARANGAY HALL TELEPHONE | Indicate the Telephone No. of Barangay Hall (Landline or NUMBER Mobile Nos.) E-MAIL ADDRESS EDUCATIONAL ATTAINMENT: Indicate the e-mail address (official or personal) This part of the BOIS contains the highest educational attainment of the barangay official HIGHEST EDUCATIONAL Check the highest level of education attained by the ATTAINMENT barangay offical. Specify whether a Graduate or an Undergraduate of that educational level EDUCATIONAL STATUS ‘Check the status if Graduate or Undergraduate OCCUPATION: This part of the BOIS contains the current occupation of the Barangay Official. OCCUPATION Indicate the barangay official's profession/occupation, if Lany a Indicate the actual amount being received as barangay official per month (elective and appointive) BENEFICIARIES: This part of the BOIS contains the beneficiaries of the barangay official that is being used as reference in processing the Death and Burial Assistance of the deceased barangay official pursuant to EO 115 and DILG MC No. 2022-132. This is only applicable to Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer. NAME Indicate the FULL NAME/S of the eligible beneficiaries (LAST, FIRST Ml) DATE OF BIRTH Indicate the Complete Birth date (MM/DDIYYYY) RELATIONSHIP Indicate the relationship of the barangay official with the beneficiary/ies.