Republic of the Philippines

Department of Interior and Local Government

NATIONAL HEADQUARTES, PHILIPPINE NATIONAL POLICE
Camp Crane, Quezon City

Badge No.
2X2 PNP PERSONAL DATA SHEET
TIN No.
PICTURE
PhilHealth No.

Warning:
The correctness of all statement or entries made herein is subject to verification and any deliberate omission or
distortion of information may give sufficient cause for investigation.

Date Accomplished:____________________________________

I. GENERAL INFORMATION
1. NAME (Last Name, First Name, Middle Name, Qualifier)

2. RANK 3. DESIGNATION 4. DATE DESIGNATED

Patrolman
5. UNIT/STATION/ADDRESS 6. TEL. NR.

7. HOME ADDRESS
B
8. DATE OF BIRTH 9. PLACE OF BIRTH

10. SEX 11. CIVIL STATUS 12. RELIGION

13. COLOR OF HAIR 14. COLOR OF EYES 15. HIEGHT(cms) 16. WEIGHT (kgs)

17. BLOOD TYPE: 18. BUILD: 19. COMPLEXION:

20. IDENTIFYING MARKS 21. LANGUAGE/DIALECT(Read/Write/Speak) 22. ETHNIC GROUP

23. NAME OF SPOUSE OR NEAREST KIN/ADDRESS 24. OCCUPATION

25. DEPENDENTS
NAME DATE OF BIRTH RELATIONSHIP ADDRESS

26. HOUSING DATA

[ ] OWN HOUSE & LOT [ ] RENT HOUSE [ ] OCCUPYING GOVT QTRS
[ ] OWN HOUSE OLY [ ] RENT HOME [ ] OTHERS (SPECIFY)______________

________________________________
Signature
 II. APPOINMNET DATA
27. EEFECTIVE DATE OF 28. STATUS OF PRESENT 29. IF TEMPORARY, STATE REASON
PRESENT APPOINTMENT APPOINTMENT

30. CHARACTER OF PRESENT APPOINTMENT

31. ORIGINAL RANK 32. NAME OF ORIGINAL ASSIGNMENT
33. DATE OF ORIGINAL APPOINTMENT 34. ORIGINAL APPOINTMENT STATUS

35. SOURCE OF COMMISSION/ENTRY TO THE PNP

III. EDUCATION ABACKGROUND

Degree Honor
Level Name of School Location Inclusive Date
Completed Received
ELEMENTARY
HIGH SCHOOL
VOCATIONAL

COLLEGE

GRADUATE
SCHOOL

IV. POLICEL/MILITARY TRAINING/SCHOOLARSHIP COURSE

Course Taken School Location Inclusive Date Trng Conducted by

Hour
s

_______________________
Signature

V. POLICE CIVIL SERVICE/NAPOLCOM/PRC ELEGIBILITIES

 Rating
Title of Exam Date Taken Where Taken
Obtained

VI. PNP OCCUPATIONAL SPECIALTY (POS) / QUALIFICATION / SKILLS

Police Occupational Nr Year of Unit/Assignment/Place of
Relevant Course/Training
Specialty (POS) Experience Practice

VII. SERVICE RECORD (GOVERNMENT, MILITARY, POLICE)

Monthly Appointment
Inclusive Date Position/Rank Name/Location Authority
Salary Status

VIII. PROMOTION RECORD (UNIFORMED SERVICE)

PROMOTION
OLD RANK NEW RANK EFF DATE AUTHORITY
STATUS

__________________________
Signature

IX. MEDALS/AWARDS COMMENDATIONS REWARD

NATURE OF AWARD DATE AWARDED AUTHORITY

 X. FIREARMS RECORD

MR/LIC NO. KIND MAKE CALIBER AMMO ISSUING UNIT

XI. PHYSICAL and MEDICAL RECORDS

Date of Last Physical and Medical Examination Where Taken

Date of Last Dental Examination Where Taken

Date of Last NP Examination Where Taken

XII. OFFENSE DATA

DISPOSITION
Type of Charge (Exonerated, convicted,
Offense Committed as Charged
(State whether administrative/criminal) Pending)
(State penalty, if convicted)

XIII. PERFORMANCE/EVALUATION RATING (LAST TWO CONSECUTIVE RATING PERION)

RATING PERIOD RATING RATER

XIV. DATA ON PREVIOUS RETIREMENT/DISMISSAL/RELATION/RESIGNATION/SUSPENSION/OTHERS

Have you ever been retired, dismissed, forced to resign or suspended from any employment for reason other than lack
funds?

Yes No If yes, give particulars

Have you ever been a candidate in a national or local election (including Barangay elections)?

Yes No If yes, give particulars

POSITION PLACE DATE

__________________
Signature

XV. REFERENCE (Persons not related by consanguinity of affinity)

NAME ADDRESS
 XVI. PLEASE COPY IN OWN HANDWRITING

“Our London Business is good but Vienna and Berlin are quite. Mr. D Lord has gone to Switzerland and I hope for
goodness. He will be there for a week at 1946 Zernatt St, and then goes to Turnie and Rome and will join Col. Perry”

XVII. CERTIFICATION
THIS IS TO CERTIFY that the answers given above are true and correct to the best of my knowledge and belief.

_______________________________________
SIGNATURE OVER PRINTED NAME

LEFT RIGHT

Subscribed and sword to before me this ____________ day of ____________, 2019 at ________________________________
Philippines.

______________________________________________
Administering Officer