Republic of the Philippines
Department of Interior and Local Government
NATIONAL HEADQUARTES, PHILIPPINE NATIONAL POLICE
Camp Crane, Quezon City
Badge No.
2X2 PNP PERSONAL DATA SHEET
TIN No.
PICTURE
PhilHealth No.
Warning:
The correctness of all statement or entries made herein is subject to verification and any deliberate omission or
distortion of information may give sufficient cause for investigation.
Date Accomplished:____________________________________
I. GENERAL INFORMATION
1. NAME (Last Name, First Name, Middle Name, Qualifier)
2. RANK 3. DESIGNATION 4. DATE DESIGNATED
Patrolman
5. UNIT/STATION/ADDRESS 6. TEL. NR.
7. HOME ADDRESS
B
8. DATE OF BIRTH 9. PLACE OF BIRTH
10. SEX 11. CIVIL STATUS 12. RELIGION
13. COLOR OF HAIR 14. COLOR OF EYES 15. HIEGHT(cms) 16. WEIGHT (kgs)
17. BLOOD TYPE: 18. BUILD: 19. COMPLEXION:
20. IDENTIFYING MARKS 21. LANGUAGE/DIALECT(Read/Write/Speak) 22. ETHNIC GROUP
23. NAME OF SPOUSE OR NEAREST KIN/ADDRESS 24. OCCUPATION
25. DEPENDENTS
NAME DATE OF BIRTH RELATIONSHIP ADDRESS
26. HOUSING DATA
[ ] OWN HOUSE & LOT [ ] RENT HOUSE [ ] OCCUPYING GOVT QTRS
[ ] OWN HOUSE OLY [ ] RENT HOME [ ] OTHERS (SPECIFY)______________
________________________________
Signature
II. APPOINMNET DATA
27. EEFECTIVE DATE OF 28. STATUS OF PRESENT 29. IF TEMPORARY, STATE REASON
PRESENT APPOINTMENT APPOINTMENT
30. CHARACTER OF PRESENT APPOINTMENT
31. ORIGINAL RANK 32. NAME OF ORIGINAL ASSIGNMENT
33. DATE OF ORIGINAL APPOINTMENT 34. ORIGINAL APPOINTMENT STATUS
35. SOURCE OF COMMISSION/ENTRY TO THE PNP
III. EDUCATION ABACKGROUND
Degree Honor
Level Name of School Location Inclusive Date
Completed Received
ELEMENTARY
HIGH SCHOOL
VOCATIONAL
COLLEGE
GRADUATE
SCHOOL
IV. POLICEL/MILITARY TRAINING/SCHOOLARSHIP COURSE
Course Taken School Location Inclusive Date Trng Conducted by
Hour
s
_______________________
Signature
V. POLICE CIVIL SERVICE/NAPOLCOM/PRC ELEGIBILITIES
Rating
Title of Exam Date Taken Where Taken
Obtained
VI. PNP OCCUPATIONAL SPECIALTY (POS) / QUALIFICATION / SKILLS
Police Occupational Nr Year of Unit/Assignment/Place of
Relevant Course/Training
Specialty (POS) Experience Practice
VII. SERVICE RECORD (GOVERNMENT, MILITARY, POLICE)
Monthly Appointment
Inclusive Date Position/Rank Name/Location Authority
Salary Status
VIII. PROMOTION RECORD (UNIFORMED SERVICE)
PROMOTION
OLD RANK NEW RANK EFF DATE AUTHORITY
STATUS
__________________________
Signature
IX. MEDALS/AWARDS COMMENDATIONS REWARD
NATURE OF AWARD DATE AWARDED AUTHORITY
X. FIREARMS RECORD
MR/LIC NO. KIND MAKE CALIBER AMMO ISSUING UNIT
XI. PHYSICAL and MEDICAL RECORDS
Date of Last Physical and Medical Examination Where Taken
Date of Last Dental Examination Where Taken
Date of Last NP Examination Where Taken
XII. OFFENSE DATA
DISPOSITION
Type of Charge (Exonerated, convicted,
Offense Committed as Charged
(State whether administrative/criminal) Pending)
(State penalty, if convicted)
XIII. PERFORMANCE/EVALUATION RATING (LAST TWO CONSECUTIVE RATING PERION)
RATING PERIOD RATING RATER
XIV. DATA ON PREVIOUS RETIREMENT/DISMISSAL/RELATION/RESIGNATION/SUSPENSION/OTHERS
Have you ever been retired, dismissed, forced to resign or suspended from any employment for reason other than lack
funds?
Yes No If yes, give particulars
Have you ever been a candidate in a national or local election (including Barangay elections)?
Yes No If yes, give particulars
POSITION PLACE DATE
__________________
Signature
XV. REFERENCE (Persons not related by consanguinity of affinity)
NAME ADDRESS
XVI. PLEASE COPY IN OWN HANDWRITING
“Our London Business is good but Vienna and Berlin are quite. Mr. D Lord has gone to Switzerland and I hope for
goodness. He will be there for a week at 1946 Zernatt St, and then goes to Turnie and Rome and will join Col. Perry”
XVII. CERTIFICATION
THIS IS TO CERTIFY that the answers given above are true and correct to the best of my knowledge and belief.
_______________________________________
SIGNATURE OVER PRINTED NAME
LEFT RIGHT
Subscribed and sword to before me this ____________ day of ____________, 2019 at ________________________________
Philippines.
______________________________________________
Administering Officer
