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 : CITY/MUN :

PROVINCE : 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 Under Graduate

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:

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

BOIS Form 001 Revised 2017

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