HEADQUARTER

COLEGIO DE LA PURISIMA CONCEPCION ROTC UNIT

603RD (CAPIZ) COMMUNITY DEFENSE CENTER, 6RCDG,
Arzobispo St., Roxas City

ROTC REGISTRATION FORM

Official Receipt No:_______760203_______ MS:__1____Date: ______SEPTEMBER 14, 2020_________
Name: ARBOLERAS REY STEPHEN D.
(Last Name) (First Name) (Middle Initial)
Temporary Address:
No./St. Vill./Brgy:_
Municipality:
Province:_
Telephone/Cell Number:___________ School Campus:__CPC BLVD. ___
Course:__BSCE __Sex :_MALE _ Religion: __ROMAN CATHOLIC_________
Date of Birth: 11/17/2002 Place of Birth: PRESIDENT ROXAS, CAPIZ
Height: 1.77m Weight: 65kg Complexion: TAN BROWN Blood Type:_O_
Permanent Address:
No./St. Vill./Brgy: HANGLID
Municipality: PRESIDENT ROXAS
Province: CAPIZ
Telephone/ Cell Number: 09493912715
Father: REYNALDO ARBOLERAS Occupation: SUGARCANE WORKER
Mother: STEPHANIE GRACE ARBOLERAS Occupation: HOUSEWIFE
Person to be notified in case of emergency:
Name: STEPHANIE GRACE ARBOLERAS Relation: MOTHER
Address: HANGLID, PRESIDENT ROXAS, CAPIZ Tel No. 09062422055
Military Science completed: (State if you have finished previous ROTC Military Science- for transferee etc.)
MS SCHOOL SEMESTER SCHOOL YEAR GRADUATED REMARKS
____ __________________ _________________________ ______________________________________________
____ __________________ _________________________ _____________________________________________
____ __________________ _________________________ _____________________________________________
____ __________________ _________________________ _____________________________________________
____ __________________ _________________________ ______________________________________________
____ __________________ _________________________ ______________________________________________
Are you welling to take the Advance Course? ( ) Yes ( ) No

REY STEPHEN ARBOLERAS

( Printed Name & signature of Student )
REGIE E GRAGASIN
COL FA GSC (RET) PA
Commandant
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HEADQUARTERS
COLEGIO DE LA PURISIMA CONCEPCION ROTC UNIT
603RD (CAPIZ) COMMUNITY DEFENSE CENTER, 6RCDG, ARESCOM
Arzobispo St., Roxas City
CPCRU Date________________________
CERTIFICATION
TO WHOME IT MAY CONCERN:
THIS IS TO CERTIFY that ___________________________________College__________ __________Campus
Is duly registered in the ______________________________ROTC Program for the______________ Semester School
Year______________________________ .

REGIE E GRAGASIN
COL FA GSC (RET)PA
Commandant