BARANGAY OFFICIAL’S INFORMATION SHEET

(ELECTIVE OFFICIALS)

REGION______________________ CITY/MUN _______________________

PROVINCE____________________ BARANGAY_______________________

POSITION: Punong Barangay Sangguniang Barangay Member

TERM IN THE PRESENT POSITION First Second Third

PERSONAL INFORMATION

NAME

(Last) (First) (Middle) (Ext)

Date of Birth Place of Birth__________________________

MM DD YYYY

Sex Male Civil Status SINGLE WIDOW/ER

Female MARRIED SEPARATED

HIGHEST EDUCATIONAL ATTAINMENT ELEM HIGH SCH COLLEGE POST GRAD.

Please Specify Graduate Under Graduate

OCCUPATION ___________________________________________________________

RESIDENCE ADDRESS ___________________________________________________________

House No./ Street Name
CONTACT NUMBER

BGY. HALL TEL NO. RES TEL NO.

CELLPHONE NO. EMAIL ADD__________________________

BENEFICIARIES
NAME DATE OF BIRTH RELATIONSHIP
1._______________________________ _________________________ ______________________
2._______________________________ _________________________ ______________________
3._______________________________ _________________________ ______________________
4._______________________________ _________________________ ______________________
5._______________________________ _________________________ ______________________

I hereby certify that the above mention are true and correct to the best of my knowledge

________________________ ________________________
Signature Over Printed Name Date Accomplished

Certified by:
RAFUNZEL S. BERO
MLGOO
 BARANGAY OFFICIAL’S INFORMATION SHEET
(APPOINTED OFFICIALS)

REGION______________________ CITY/MUN _______________________

PROVINCE____________________ BARANGAY_______________________

POSITION: Barangay Treasurer Barangay Secretary Sangguniang Barangay Member

TERM IN THE PRESENT POSITION First Second Third

PERSONAL INFORMATION

NAME

(Last) (First) (Middle) (Ext)

Date of Birth Place of Birth__________________________

MM DD YYYY

Sex Male Civil Status SINGLE WIDOW/ER

Female MARRIED SEPARATED

HIGHEST EDUCATIONAL ATTAINMENT ELEM HIGH SCH COLLEGE POST GRAD.

Please Specify Graduate Under Graduate

OCCUPATION ___________________________________________________________

RESIDENCE ADDRESS ___________________________________________________________

House No./ Street Name
CONTACT NUMBER

BGY. HALL TEL NO. RES TEL NO.

CELLPHONE NO. EMAIL ADD__________________________

BENEFICIARIES
NAME DATE OF BIRTH RELATIONSHIP
1._______________________________ _________________________ ______________________
2._______________________________ _________________________ ______________________
3._______________________________ _________________________ ______________________
4._______________________________ _________________________ ______________________
5._______________________________ _________________________ ______________________

I hereby certify that the above mention are true and correct to the best of my knowledge

________________________ ________________________
Signature Over Printed Name Date Accomplished

Certified by:
RAFUNZEL S. BERO
MLGOO