BOIS Form 001 Revised 2017

1X1
Republic of the Philippines ID Picture
Department of the Interior and Local Government
Province of Cagayan
MUNICIPALITY OF LAL-LO

BARANGAY OFFICIAL'S INFORMATION SHEET

REGION : II MUNICIPALITY : LAL-LO

PROVINCE : CAGAYAN BARANGAY :

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 Undergraduate

OCCUPATION: HONORARIUM:

BENEFICIARIES:
NAME DATE OF BIRTH RELATIONSHIP
1.
2.
3.
4.
5.

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:

ROSHSEINEE O. GUMABAO
MLGOO Date