ANNEX “A”

BOIS Form Revised 2022

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 : 02 CITY/MUN : QUEZON

PROVINCE : ISABELA BARANGAY : Turod

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
6378- 2917-2407-5238

(PhilSys Card No.)

BANIAGA KURT IVAN SUTI

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

06/ 03/ 2005 TUROD,QUEZON.ISABELA M SINGLE ROMAN CATHOLIC

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

PUROK 7 TUROD, QUEZON, ISABELA

(Residence Address) (Residence Telephone No.)

0977O725526
(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: STUDENT HONORARIUM:

BENEFICIARIES: (optional for the other appointive barangay officials)

NAME DATE OF BIRTH RELATIONSHIP

1. GERONIMO H. BANIAGA JUNE 23, 1974 FATHER

2. LEONORA S. BANIAGA OCTOBER 21, 1978 MOTHER

3 KEIN IRA S. BANIAGA DECEMBER 9, 2008 BROTHER

4.
(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.

KURT IVAN BANIAGA NOVEMBER 4, 2023

(Signature over Printed Name) (Date Accomplished)

Verified and validated by:

FERDINAND H. MIGUEL

MLGOO Date
(Signature over Printed Name)