Republic of the Philippines

DEPARTMENT OF EDUCATION
Regional Office No. 02
Regional Government Center, Carig Sur, Tuguegarao City

PSU FORMOl

PERSONAL DATA SHEET

Employee N o : - - - - - - - - - - - - - - -
(to be filled up by PSU Personnel)

Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~------
(First Name) (Middle Name) (Last Name)

Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___

Date of Birth:--------------- Civil Status: _ _ _ Age: _ _ _ _ Sex: _ _ _ __

D i v i s i o n : - - - - - - - - - District: - - - - - - - - - - - - - - - - - - - - -
School: ______________________________________________________

P o s i t i o n : - - - - - - - - - - - - - - - - - - Item N o . - - - - - - - - - - - - - - - - -

Employment S t a t u s : - - - - - - - - - - - - - - - ( ) New ( ) Transferee

(In case of transferee please attach payslip or list of deductions from previous station)

Date of Appointment:----------- Salary Grade: _ _ __ Step: _ _ _ __

Basic Salary:

ATM No:

TIN No:

GSIS BPNo:

Philhealth No:

Pagibig ID No.

For withholding Tax Purposes please attached Xerox copy of BIR Form 2305/1902.

I HEREBY CERTIFY that above information are true and correct.

{Signature Over Printed Name}