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Information Sheet: National Telecommunications Commission
Information Sheet: National Telecommunications Commission
Information Sheet: National Telecommunications Commission
INFORMATION SHEET
Any deliberate emission or distortion of material facts may give sufficient cause for denial of application.
1.
Name
_____________________________________________________________________ __________
(Surname)
(First Name)
(Middle Name)
(Alias)
2.
Change of name (if court action, give details) _______________________________________ __________
3.
Birth date ________________ Birth Place _____________________________________________________
4.
Citizenship _____________________, if naturalized, state previous citizenship, place date and Naturalization
Certificate No. _______________________________________________________________
5.
Physical Description: Sex: ____________Height (cm) _____________Weight (kg) ___________________
6.
Civil Status: ____________
Name of Spouse: ______________________________________________
7.
Name of Mother: ______________________
Occupation: _______________________________
8.
Name of Father: _________________________
Occupation: ________________________
9.
Name of Brothers and Sisters:_____________________________
______________________________
10.
Home Address: _______________________________________________________________ __________
Tel. No. _____________________
_____ Cell Phone No.
11.
Place of Residence since birth: ________________________________________________________________
12.
Employment:
Name of Employment/Company/Office: _____________________________________________ __________
Name of Business: _____________________________________________________________ __________
Designation/Position: ___________________________________________________________ __________
Business Address: _____________________________________________________________ __________
Telephone No. ___________________________ Fax No._____________________________ __________
13.
Schools Attended:
Name of School
Location
Course/Degree Date
Secondary:____________________________________________________________________________
College: ______________________________________________________________________________
Others: _______________________________________________________________________________
14.
List of Organization of which you are/have been a member (Schools, Civic or Religious Organization):
Organization
Address
Position
Inclusive Dates
____________________________________________________________________________ __________
Have you been arrested, convicted for any violation of laws or charged in any administrative case? ____,
if yes, state the name of court, nature of offense and disposition of the case
____________________________________________________________________________ __________
I CERTIFY that the foregoing are true and correct to the best of knowledge and belief and I AGREE that any
misstatement or omission as to the material fact(s) will constitute ground for immediate denial of my application.
Signed at ____________________________________________ Date ___________________ __________
_______________________________
(Name and Signature of Applicant)
Subscribe and sworn to before this ________th day of _________________________________ __________
affiant having his/her Residence Certificate No. _______________________________________, issued at
______________________________________ issued on _______________________________ __
Doc. No.
Page No.
Book No.
Series No.
______________
______________
______________
______________
NOTARY PUBLIC