BOIS Form 001 Revised 2017

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ID Picture
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 : VI CITY/MUN : IGBARAS

PROVINCE : ILOILO BARANGAY : IGTALONGON

ELECTIVE AND APPOINTIVE POSITION

Punong Barangay
Barangay Treasurer
Sangguniang Barangay Member
Barangay Secretary
Rank (1, 2, 3, 4, 5, 6, 7)
Relationship with the Appointing Authority: _
SK Chairman
IPMR
SK Member
other Appointive Barangay Official:
TERM IN THE PRESENT POSITION:
BRGY. POLICE SAFETY OFFICER
1st 2nd 3rd

PERSONAL INFORMATION

ELLANA TEODORO EGBALIC

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

09/01/1972 IGBARAS, ILOILO MALE MARRIED ROMAN CATHOLIC

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

BRGY. IGTALONGON IGBARAS, ILOILO

(Residence Address) (Residence Telephone No.)

NONE

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

HIGHEST EDUCATIONAL
ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD
ATTAINMENT: VOCATIONAL

Please specify:
Graduate Under Graduate

OCCUPATION: FARMING HONORARIUM: PHP. 1,000.00

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.

TEODORO E. ELLANA
(Signature Over Printed Name) (Date Accomplished)

Verified and validated by:

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