BOIS Form 001 Revised 2018

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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 : CAR CITY/MUN : Sabangan

PROVINCE: MOUNTAIN PROVINCE BARANGAY : Namatec

ELECTIVE AND APPOINTIVE POSITION

Punong Barangay Barangay Treasurer
Sangguniang Barangay Member Barangay Secretary
Rank (1, 2, 3, 4, 5, 6, 7) Relationship with the Appointing Authority: _______________

SK Chairperson IPMR
SK Member other Appointive Barangay Official:

TERM IN THE PRESENT POSITION _________________________________

1st 2nd 3rd

PERSONAL INFORMATION

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

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

*(Residence Address) (Residence Telephone No.)

*(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: HONORARIUM:

*BENEFICIARIES: (this portion is not applicable to the other appointive barangay officials i.e. Lupon, Tanod, BHW, etc.)
NAME DATE OF BIRTH RELATIONSHIP
1.

2.

3.

4.

5.

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

(Signature Over Printed Name) (Date Accomplished)

Verified and validated by:

CD/CLGOO/MLGOO Date
(Signature Over Printed Name)